Maternal-Child McKinney Ch 32: Women's HealthCare

1. Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap test?

a. Gloves and eye protectors

b. Speculum

c. Fixative agent

d. Lubricant

ANS: D Lubricant

Lubricants interfere with the accuracy of the cytology report. Gloves and eye protectors, speculum, and a fixative agent are all used during the exam.

2. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called

a. bimanual palpation.

b. rectovaginal palpation.

c. a Papanicolaou test.

d. DNA testing.

ANS: C a Papanicolaou test.

The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the patient's age. Bimanual palpation is a physical examination of the vagina,. rectovaginal palpation is a physical examination performed through the rectum, and DNA testing for the various types of HPV that cause cervical cancer is now available. Samples are collected in the same way as a Pap test.

3. The nurse providing care in a women's health care setting must be aware that which sexually transmitted disease (STD) can be cured?

a. Herpes

b. Acquired immunodeficiency syndrome (AIDS)

c. Venereal warts

d. Chlamydia

ANS: D Chlamydia

The usual treatment for chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the main focus. Condylomata acuminata (venereal warts) is caused by the human papillomavirus. No treatment eradicates the virus.

4. Which statement by a woman diagnosed with premenstrual syndrome indicates that further health teaching is needed?

a. "I may have to try some antidepressants."

b. "I need to limit my intake of caffeine."

c. "I might try taking some vitamin E."

d. "Salty foods will not affect this condition."

ANS: D "Salty foods will not affect this condition."

Eating salty foods contributes to edema and fluid retention and should be avoided as much as possible. This statement indicates a lack of understanding. The other statements are all accurate.

5. Which statement by the patient indicates that she understands breast self-examination?

a. "I will examine both breasts in two different positions."

b. "I will perform breast self-examination 1 week after my menstrual period starts."

c. "I will examine the outer upper area of the breast only."

d. "I will use the palm of the hand to perform the examination."

ANS: B "I will perform breast self-examination 1 week after my menstrual period starts."

The woman should examine her breasts when hormonal influences are at a low level, typically the week after her menses. Women who don't menstruate should pick a date and perform SBE on that date every month. She should 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. She should use the sensitive pads of the middle three fingers.

6. A benign breast condition that includes dilation and inflammation of the collecting ducts is called

a. ductal ectasia.

b. intraductal papilloma.

c. chronic cystic disease.

d. fibroadenoma.

ANS: A ductal ectasia.

Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. Fibroadenoma is fibrous and glandular tissue. They are felt as firm, rubbery, and freely mobile nodules.

7. Which patient is most at risk for fibroadenoma of the breast?

a. A 38-year-old woman

b. A 50-year-old woman

c. A 16-year-old woman

d. A 27-year-old woman

ANS: C A 16-year-old woman

Although it may occur at any age, fibroadenoma is most common in the teenage years.

8. Adjuvant treatment with tamoxifen may be recommended for patients with breast cancer if the tumor is

a. smaller than 5 cm.

b. located in the upper outer quadrant only.

c. contained only in the breast.

d. estrogen receptive.

ANS: D estrogen receptive.

Tamoxifen is antiestrogen therapy for tumors stimulated by estrogen. Tamoxifen is used depending on age, stage, and hormone receptor status, not size. Location of the cancer does not determine the usefulness of tamoxifen. Stage of the cancer is a consideration, but more important is its sensitivity to estrogen.

9. Which statement is true about primary dysmenorrhea?

a. It occurs in young multiparous women.

b. It is experienced by all women.

c. It may be due to excessive endometrial prostaglandin.

d. It is unaffected by oral contraceptives.

ANS: C It may be due to excessive endometrial prostaglandin.

Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It usually occurs in young nulliparous women. It is not experienced by all women. Oral contraceptives can be a treatment choice.

10. In helping a patient manage PMS, the nurse should

a. recommend a diet with more red meat and sugar.

b. suggest herbal therapies and massage.

c. tell the patient to ask for medications as soon as symptoms occur.

d. suggest the use of diuretics.

ANS: B suggest herbal therapies and massage.

Herbal therapies, conscious relaxation and massage have all been reported to have a beneficial effect on PMS. Carbohydrates may decrease cravings. Medications can be tried if lifestyle changes do not help or if there are depressive symptoms. Diuretics are not usually prescribed.

11. With regard to endometriosis, nurses should be aware that

a. it is characterized by the presence and growth of endometrial tissue inside the

uterus.

b. it affects 25% of all women.

c. it may worsen with repeated cycles or remain asymptomatic and disappear after

menopause.

d. it is unlikely to affect sexual intercourse or fertility.

ANS: C it may worsen with repeated cycles or remain asymptomatic and disappear after

menopause.

Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis affects 10% of all women and is found equally in Caucasian and African-American women. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Women can experience painful intercourse and impaired fertility.

12. A 49-year-old patient confides to the nurse that she has started experiencing pain with intercourse and asks, "Is there anything I can do about this?" What is the best response by the nurse?

a. "You need to be evaluated for a sexually transmitted disease."

b. "Water-soluble vaginal lubricants may provide relief."

c. "No, it is part of the aging process."

d. "You may have vaginal scar tissue that is producing the discomfort."

ANS: B "Water-soluble vaginal lubricants may provide relief."

Loss of lubrication with resulting discomfort in intercourse is a symptom of estrogen deficiency. This is a normal occurrence with the aging process and does not indicate STDs. It is part of the aging process, but the use of lubrication will help relieve the symptoms. It is due to loss of lubrication with the decrease in estrogen and not scar tissue formation.

13. A 70-year-old woman should be taught to report what condition to her health care provider?

a. Vaginal bleeding

b. Pain with intercourse

c. Breasts become smaller

d. Skin becomes thinner

ANS: A Vaginal bleeding

Vaginal bleeding after menopause should always be investigated. It is highly suggestive of endometrial cancer. The other conditions are related to aging.

14. Which woman is most likely to have osteoporosis?

a. A 50-year-old woman receiving estrogen therapy

b. A 60-year-old woman who takes supplemental calcium

c. A 55-year-old woman with a sedentary lifestyle

d. A 65-year-old woman who walks 2 miles each day

ANS: C A 55-year-old woman with a sedentary lifestyle

Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D. Weight-bearing exercises have been shown to increase bone density.

15. A woman with a history of a cystocele should contact the physician right away if she experiences

a. involuntary loss of urine when she coughs.

b. constipation.

c. backache.

d. urinary frequency and burning.

ANS: D urinary frequency and burning.

Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Involuntary loss of urine during coughing is stress incontinence and is not an emergency. Constipation may be a problem with rectoceles. Back pain is a symptom of uterine prolapse.

16. To assist the woman in regaining control of the urinary sphincter, the nurse should teach her to

a. practice Kegel exercises.

b. void every hour while awake.

c. allow the bladder to become full before voiding.

d. restrict fluids to limit incontinent episodes.

ANS: A practice Kegel exercises.

Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. Voiding every hour is too frequent and not realistic. Overdistention of the bladder will contribute to incontinence. Restricting fluids will cause bladder irritation that increases the problem.

17. The physician diagnoses a 3-cm ovarian cyst in a 28-year-old woman. The nurse expects the initial treatment to include

a. beginning hormone therapy.

b. examining the woman after her next menstrual period.

c. scheduling a laparoscopy as soon as possible, to remove the cyst.

d. aspirating the cyst as soon as possible and sending the fluid to pathology.

ANS: B examining the woman after her next menstrual period.

If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again. Cysts in women of childbearing age may decrease within one cycle, so treatment is not necessary at this point.

18. The drug of choice to treat gonorrhea is

a. penicillin G.

b. tetracycline.

c. ceftriaxone.

d. acyclovir.

ANS: C ceftriaxone.

Penicillin is the drug of choice used to treat syphilis.

19. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?

a. Increasing the intake of red meat and simple carbohydrates

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 Using a heating pad on the abdomen to relieve cramping

Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes are not needed. Physical activity is beneficial for everyone but is not a treatment for this condition.

20. Nafarelin (Synarel) is currently used as a treatment for mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug

a. stimulates the secretion of gonadotropin-releasing hormone (GnRH).

b. may produce masculinizing effects.

c. must be continued for at least a year.

d. can cause her to experience some hot flashes and vaginal dryness.

ANS: D can cause her to experience some hot flashes and vaginal dryness.

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. Danazole, another mediction to treat endometriosis causes masculinizing effects. Nararelin is used for 3 to 6 months usually.

21. The nurse who is teaching a group of women about breast cancer should tell the women that

a. risk factors identify almost all women who will develop breast cancer.

b. African-American women have a higher rate of breast cancer.

c. 1 in 10 women in the United States will develop breast cancer in her lifetime.

d. the exact cause of breast cancer is unknown.

ANS: D the exact cause of breast cancer is unknown.

The exact cause of breast cancer in unknown. Risk factors help identify women who may get breast cancer and for whom increased surveillance is recommended; however, breast cancer can occur without risk factors. Caucasian women have a higher incidence of breast cancer; however, African-American women have a higher rate of dying of breast cancer after they are diagnosed. One in eight women in the United States will develop breast cancer in her lifetime.

22. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are

a. a disease of the milk ducts and glands in the breasts.

b. a pre-malignant disorder characterized by lumps found in the breast tissue.

c. lumpiness with pain and tenderness found in the breasts of healthy women.

d. lumpiness accompanied by tenderness after menses.

ANS: C lumpiness with pain and tenderness found in the breasts of healthy women.

Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are palpable thickenings in the breast. Fibrocystic changes are not pre-malignant changes. This information is inaccurate. Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. Most often tenderness occurs prior to menses.

23. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?

a. Mammogram

b. Ultrasound

c. Core needle biopsy

d. MRI

ANS: C Core needle biopsy

When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or one of the other types of biopsies. A mammogram screens for breast cancer. An ultrasound may be used with or before biopsy. An MRI might be used in select cases.

24. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this patient, the nurse should know that

a. fibroids are malignant tumors of the uterus.

b. fibroids will increase in size during the perimenopausal period.

c. abnormal uterine bleeding is a common finding.

d. hysterectomy should be performed.

ANS: C abnormal uterine bleeding is a common finding.

The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large leimyomas. Excessive menstrual bleeding is one possible symptom of fibroids. They are benign. They atrophy during menopause. A hysterectomy may be performed if the woman does not want more children and other therapies are not successful. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen-sensitive and shrink as levels of estrogen decline.

25. When assessing a woman for menopausal discomforts, the nurse expects the woman to describe the most frequently reported discomfort, which is

a. headaches.

b. hot flashes.

c. mood swings.

d. vaginal dryness with dyspareunia.

ANS: B hot flashes.

Vasomotor instability, in the form of hat flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches are not a commonly reported symptom. Mood swings and vaginal dryness with dyspareunia do occur but are not the most commonly reported symptom.

26. While evaluating a patient for osteoporosis, the nurse should be aware of what risk factor?

a. African-American race

b. Low protein intake

c. Obesity

d. Cigarette smoking

ANS: D Cigarette smoking

Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.

27. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse should include the risks of

a. breast cancer.

b. vaginal and urinary tract atrophy.

c. osteoporosis.

d. arteriosclerosis.

ANS: A breast cancer.

Women with a high risk of breast cancer should be counseled against using ERT. Estrogen prevents atrophy of vaginal and urinary tract tissue and protects against the development of osteoporosis. Estrogen has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol and increasing high-density lipoprotein (HDL). It also has a direct antiatherosclerotic effect on the arteries.

28. During her annual gynecologic checkup, a woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse should document this complaint as

a. amenorrhea.

b. dysmenorrhea.

c. dyspareunia.

d. PMS.

ANS: B dysmenorrhea.

Dysmenorrhea is pain during or shortly before menstruation. Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. 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.

29. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a patient with this condition should be aware that the optimal pharmacologic therapy for pain relief is

a. acetaminophen.

b. oral contraceptives (OCPs).

c. nonsteroidal anti-inflammatory drugs (NSAIDs).

d. aspirin.

ANS: C nonsteroidal anti-inflammatory drugs (NSAIDs).

Nonsteroidal anti-inflammatory medications are the first-line drug for primary dysmenorrhea. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have a number of potential side effects. Aspirin is usually not as effective as NSAIDs but can be used.

30. A woman is 6 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the first trimester is

a. administration of prostaglandins.

b. dilation and evacuation.

c. intravenous administration of Pitocin.

d. vacuum aspiration.

ANS: A administration of prostaglandins.

The most common technique for medical termination of a pregnancy within the first 7 weeks of pregnancy is administration of prostaglandins. D&C is the most common method of surgical abortion used if medical abortion fails. Pitocin would not be used. Vacuum aspiration is used in the first trimester.

31. The nurse should be aware that a pessary is most effective in the treatment of what disorder?

a. Cystocele

b. Uterine prolapse

c. Rectocele

d. Stress urinary incontinence

ANS: B Uterine prolapse

A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. It is not used for cystocele, rectocele, or incontinence.

32. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas?

a. Abnormal uterine bleeding

b. Diarrhea

c. Weight loss

d. Acute abdominal pain

ANS: A Abnormal uterine bleeding

Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas, or fibroids. Diarrhea, weight loss, and acute abdominal pain are not characteristic of fibroids.

33. A woman calls the triage nurse at the family medicine clinic and reports a raised area on her vulva. What response by the nurse is best?

a. Ask her when her next annual physical is due.

b. Make an appointment for the next day or two.

c. Send her directly to the emergency department.

d. Ask about protection she uses during sexual activity.

ANS: B Make an appointment for the next day or two.

A raised or discolored lesion of the vulva needs to be examined as soon as possible. The nurse should schedule the woman for the soonest available appointment. This could be a cancerous lesion and so should not wait until the next annual physical, so there is no reason to ask that question. While urgent, this is not something the woman should go to the ED for. The lesion is not related to STDs so asking about protection during sex is not needed.

1. Women are often reluctant to have annual mammograms for many reasons. These reasons include which of the following? (Select all that apply.)

a. Reluctance to hear bad news

b. Fear of x-ray exposure

c. Belief that lack of family history makes this test unnecessary

d. Expense of the procedure

e. Having heard that the test is painful

ANS: A, B, D, E

Common reasons women give for postponing or avoiding mammography include reluctance to hear bad news, fears of x-ray exposure, and fear of pain. Some women may believe their family history makes it unnecessary, but this is not a common statement. Expense may be an issue for some women, but hopefully with the Affordable Care Act, the number of women worried about expense is declining.

2. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? (Select all that apply.)

a. Calcium

b. Evista

c. Fosamax

d. Actonel

e. Vitamin C

ANS: A, B, C, D

Calcium, Evista, Fosamax, and Actonel are all used to prevent or treat osteoporosis. Vitamin C is not.

3. The exact cause of breast cancer remains undetermined. Researchers have found that there are a number of common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (Select all that apply.)

a. Family history

b. Late menarche

c. Early menopause

d. Race

e. Nulliparity or first pregnancy after age 30

ANS: A, D, E

Family history, race, and nulliparity or first pregnancy after age 30 are all risk factors for breast cancer. Early menarche (not late) and late (not early) menopause are also risk factors.

4. A nurse is teaching a community group of women about ways to decrease their risk of cardiovascular disease. What actions does the nurse recommend? (Select all that apply.)

a. Stop smoking

b. Drink 8 to 10 glasses of water daily

c. Exercise on most days of the week

d. Get your blood pressure checked

e. Decrease the fat in your diet

ANS: A, C, D, E

Risk factors for coronary artery disease include smoking, sedentary lifestyle, hypertension, and a high-fat diet. Drinking water is healthy but not specifically related to cardiovascular disease.