Chapter 49
1. A woman who is 24 weeks pregnant reports to the ambulatory care clinic with reports of
burning with urination and a vaginal discharge. The laboratory test confirms the presence of a
chlamydial infection. Which of the following will be included in the client’s plan of
treatment?
1. A single dose of azithromycin
2. A single dose of an oral antifungal medication such as Diflucan (fluconazole)
3. A 5-day course of therapy with doxycycline
4. A 7-day dosage of tetracycline
Answer: A single dose of azithromycin
Rationale: Chlamydia is a bacterial sexually transmitted infection. The use of a single dose of
azithromycin is indicated in the treatment of chylamydia. The use of difulcan is indicated in
the treatment of vaginal candidias infections. Doxycycline is used in the treatment of
Chlamydia but is given for 7 days. Tetracycline is an antibiotic but its use is contraindicated
in pregnancy.
2. The community health nurse will be presenting a program to discuss sexually transmitted
infections. When planning the program, which of the following concepts regarding syphilis
should be included?
1. Syphilis rates are associated with the use of crack cocaine.
2. The incidence of syphilis has decreased over the past decade.
3. The incidence of infectious syphilis is highest in men.
4. Hispanic Americans have the greatest rate of syphilis infection.
Answer: Syphilis rates are associated with the use of crack cocaine.
Rationale: The rates of syphilis are associated with the use of crack cocaine. This link is
attributed to the high-risk practice of exchanging sex for money and drugs. The rate of
syphilis infections has been increasing. Women are the largest population impacted by the
infection. African Americans have the greatest rate of infection.
3. A 23-year-old woman has presented to the emergency department. She has complaints of
abdominal pain, fever, and dyspareunia. The health care provider has diagnosed the client
with pelvic inflammatory disease. The client becomes tearful and asks how people “catch”
this infection. Which of the following should be included in the teaching provided to the
client?
Select all that apply.
1. Pelvic inflammatory disease is associated with the use of intrauterine devices for
contraception.
2. Bacterial infections may lead to pelvic inflammatory disease.
3. Pelvic inflammatory disease is associated with women who have a late age of menarche.
4. The disorder may have been transmitted by contact with articles belonging to an infected
individual.
5. This disease has resulted from an untreated case of herpes simplex.
Answers:
1. Pelvic inflammatory disease is associated with the use of intrauterine devices for
contraception.
2. Bacterial infections may lead to pelvic inflammatory disease.
Rationale: Pelvic inflammatory disease is associated with the use of intrauterine devices for
contraception. Pelvic inflammatory is an infection of the reproductive organs. It is associated
with the use of intrauterine devices for contraception. Bacterial infections may lead to pelvic
inflammatory disease. Sexually transmitted bacterial infections such as gonorrhea and
chlamydia are also associated with an increased risk in the development of the disease. Pelvic
inflammatory disease is associated with women who have a late age of menarche. Pelvic
inflammatory disease is seen in women of childbearing age who are sexually active. Age of
menarche is not a factor in the development of this illness. The disorder may have been
transmitted by contact with articles belonging to an infected individual. This illness is seen in
women of childbearing age who are sexually active. Contact with articles belonging to an
infected individual is not a factor in the development of this illness. This disease has resulted
from an untreated case of herpes simplex. The herpes simplex virus is not associated with the
development of pelvic inflammatory disease.
4. During a routine physical examination, a 22-year-old client reports she has recently had
two relatives diagnosed with breast cancer. She questions which of her personal behaviors
place her at risk for the development of the disease. Which of the following reported factors
can be implicated in the increased risk for breast cancer?
1. Onset of menarche at age 11
2. Breast-fed her two children for 6 months
3. Hispanic heritage
4. Use of the female condom
Answer: Onset of menarche at age 11
Rationale: The risk of breast cancer is increased with menarche onset before age 12. Breastfeeding children is associated with a lowered risk for the development of breast cancer.
Individuals having a Jewish heritage have an increased risk for the development of breast
cancer; there is no information supporting the disease being increased in the Hispanic
population. Breast cancer risk may be increased with the use of hormonal agents in
contraceptives such as the pill. The female condom does not have hormonal ingredients and
does not impact breast cancer risk.
5. A client reports a family member has recently been diagnosed with breast cancer. The
client voices questions about the influence of hormones on her risk for breast cancer. What
information can be provided to the client?
1. The use of hormone replacement therapy in menopausal clients is linked to an increased
risk for the development of breast cancer.
2. Early onset of menarche is associated with reduced breast cancer rates.
3. The reported association between oral contraceptive use and breast cancer is a myth.
4. Nulligravid women have a reduced risk for the development of breast cancer.
Answer: The use of hormone replacement therapy in menopausal clients is linked to an
increased risk for the development of breast cancer.
Rationale: The use of estrogen-containing hormones as found in oral contraceptives and
hormone replacement therapy is linked to an increase in the risk of development of breast
cancer. Girls having menarche before the age of 12 have an increased risk for the
development of breast cancer. Women who have not experienced a full-term pregnancy have
an increased risk for the development of breast cancer.
6. The nurse is working at an ambulatory care clinic. A woman reports with complaints of
discovering a lump in her breast. When considering the likelihood the mass is malignant,
which characteristic is most indicative of breast cancer?
1. The borders of the mass are uneven.
2. The client reports tenderness with palpation.
3. The mass is readily moved beneath the skin.
4. The skin over the mass is smooth.
Answer: The borders of the mass are uneven.
Rationale: Malignant masses typically present with uneven borders. The characteristics of a
benign mass include tenderness with palpation, ease in mobility of mass, and smooth,
unaffected skin over the mass.
7. A female patient is scheduled for a stereotactic needle biopsy of a left breast lesion.
Instructions regarding this diagnostic test should include:
1. This is a three-dimensional mammogram in which a fine needle aspirate of the mass is
taken while lying on the stomach.
2. The entire lesion is removed along with some of the surrounding tissue.
3. This is the gold standard for diagnosis in which a small cut is made in the breast under
intravenous sedation.
4. A needle will be inserted into the lesion, guided by an ultrasound, and the contents
aspirated.
Answer: This is a three-dimensional mammogram in which a fine needle aspirate of the mass
is taken while lying on the stomach.
Rationale: A stereotactic needle biopsy is a three-dimensional mammography in which the
patient lies on the stomach and a fine needle is used to aspirate the mass. An excisional
biopsy is done when complete removal of the abnormality and some surrounding tissue is
planned. An open surgical incisional biopsy is the gold standard in which less than a 2-inch
incision is made into the breast under local anesthesia or intravenous sedation. A fine needle
aspiration is where a fine needle is inserted into the lesion, guided by ultrasound, and the
contents are removed.
8. The nurse is discussing self-breast examinations with a 20-year-old client. Which of the
following statements by the client indicates the need for further education?
1. “I should examine my breasts on the first day of my menstrual period.”
2. “The fact that I have breast implants does not negate my need to perform a monthly selfbreast examination.”
3. “Lying down will help me to feel all of my breast tissue.”
4. “A firm ridge in the lower curve of my breast is normal.”
Answer: “I should examine my breasts on the first day of my menstrual period.”
Rationale: The breast examination should be performed between days 4 and 7 of the
menstrual period. The date is best when kept consistent. On day 1 of the menstrual period, the
breasts may be tender or swollen. The remaining statements are correct.
9. A 20-year-old client is being seen at the health care provider’s office for an annual physical
examination. During the data collection period, the client indicates she does not believe she is
old enough to be concerned about performing a breast self-examination. What information
should be provided to the client?
1. Women should begin to perform a monthly breast self-examination by the age of 20.
2. The breast self-examination should become a regular part of a woman’s monthly regimen
beginning at age 30.
3. If there is no family history of breast cancer, the client does not yet need to begin
performing breast self-examination.
4. The breast self-examination is not needed if the client has an annual gynecological
examination including a medical breast examination.
Answer: Women should begin to perform a monthly breast self-examination by the age of 20.
Rationale: The breast self-examination should be performed monthly by all women. Age 20 is
a recommended starting point. Not all breast cancer has been linked to genetic factors. Family
history is an inadequate means for determining the need to perform monthly breast selfexaminations. The annual gynecological examination may indeed include a breast
examination, but this is not an adequate frequency for the procedure.
10. A woman has been taught the techniques to use in performing a self-breast examination.
When reviewing her technique, which of the following actions indicates the need for further
education?
1. The woman moves her palms over the breast tissue in smooth, even strokes.
2. The woman employs firm pressure when assessing the tissue closest to her chest and ribs.
3. The woman reports that a firm ridge found in the lower curve of her right breast is no cause
for concern.
4. The woman performs the examination while lying down.
Answer: The woman moves her palms over the breast tissue in smooth, even strokes.
Rationale: The breast self-examination should be performed using the pads of her three
middle fingers to evenly palpate the breast tissue in a circular motion. The remaining answers
are correct.
11. A 32-year-old African American woman has just been diagnosed with uterine fibroid
tumors. The woman is upset and has several questions about the condition. After providing
education to her, the nurse will recognize the need for further education when the woman
makes which of the following statements?
1. “The growth of my tumors is directly linked to my progesterone levels.”
2. “These tumors are frequently seen in African American women.”
3. “These tumors are benign.”
4. “The tumors tend to develop slowly.”
Answer: “The growth of my tumors is directly linked to my progesterone levels.”
Rationale: Fibroid tumor growth is linked to estrogen production. Progesterone levels are not
tied to fibroid tumor growth. The remaining statements are correct.
12. A client who has been experiencing dysmenorrhea has come to the ambulatory care clinic.
The health care provider has diagnosed the presence of endometriosis. The client asks how
this condition is responsible for her pain. What information should be included in the
teaching provided?
1. The endometrial tissue located outside of the uterus responds to the hormones responsible
for the menstrual period.
2. The shedding of the endometrial lining during menstruation is the cause of the cramping
she has been experiencing.
3. The elevated follicle-stimulating hormones during menstruation are causing the
endometrial tissue to contract, resulting in the pains she has been experiencing.
4. The loss of blood during the menstrual period is causing a hormonal imbalance that is the
underlying cause of the pain being experienced.
Answer: The endometrial tissue located outside of the uterus responds to the hormones
responsible for the menstrual period.
Rationale: Endometriosis is the presence of endometrial tissue outside of the uterus. This
tissue is responsive to the hormones that control menstruation. The hormonal changes during
menstruation are responsible for the inflammation and pain. Shedding of the endometrial
tissue is normal and is not directly responsible for the pain being experienced. Folliclestimulating hormone plays a role in the female’s reproductive physiology only prior to
menstruation. The blood loss in the woman diagnosed with endometriosis may be greater
than normal but is not related to hormonal imbalances.
13. A woman reports to the health care provider with complaints of urinary incontinence and
abdominal/pelvic pressure. The health care provider examines the patient and diagnoses her
condition as a cystocele. Upon hearing the diagnosis, the patient reports she has heard about
this condition. When receiving education about the condition, she states she is relieved the
condition is only the result of weakening of the structures that support her uterus. What
response by the nurse is indicated?
1. “The cystocele has occurred because the bladder is pressing downward on the uterus.”
2. “I am glad you have been able to receive some background information about your
condition.”
3. “This condition is actually caused by a weakening of the uterus itself.”
4. “A cystocele is actually the result of the rectum pushing forward into the vagina.”
Answer: “The cystocele has occurred because the bladder is pressing downward on the
condition.”
Rationale: The cystocele is the result of a weakening of the wall between the vagina and the
bladder. This causes the bladder to protrude into the vaginal vault. The uterus is not weakened
in this condition. A protrusion of the rectum is known as a rectocele.
14. A client who is 4 weeks postpartum reports to the clinic with complaints of breast
tenderness and swelling. The diagnosis is mastitis. Which of the following will likely be
included in the initial plan of care?
1. Wearing of a support bra
2. Discontinue breast-feeding for 48 to 72 hours
3. The application of hot compresses
4. Antibiotic therapy for 7 days
Answer: Wearing of a support bra
Rationale: Clients will benefit from the wearing of a support bra at all times. This will
enhance comfort and provide support to the enlarged breast tissue. Breast-feeding will be
continued. The discontinuation of breast-feeding may result in engorgement and related
complications. Compresses will be prescribed, but they will alternate between warm and
cold. Antibiotic therapy may be prescribed, but only after other interventions have been
implemented and found to be unsuccessful.
15. A client 40-year-old woman has been diagnosed with breast cancer. She reports having
researched the use of tamoxifen. Which of the following statements by the client indicates an
understanding of the medication?
Select all that apply.
1. “The medication has been shown to reduce the recurrence of breast cancer by more than
10%.”
2. “The medication is a form of hormonal therapy.”
3. “The medication has been shown to reduce the mortality rate associated with breast
cancer.”
4. “The medication is best for use in perimenopausal women.”
5. “The medication is limited to use in postmenopausal women.”
Answer: 1. “The medication has been shown to reduce the recurrence of breast cancer by
more than 10%.”
2. “The medication is a form of hormonal therapy.”
3. “The medication has been shown to reduce the mortality rate associated with breast
cancer.”
Rationale: Rationale: “The medication has been shown to reduce the recurrence of breast
cancer by more than 10%.” The medication has been shown to reduce the reoccurrence of
breast cancer by 26%. “The medication is a form of hormonal therapy.” Tamoxifen is a form
of hormone therapy. The medication interferes with the ability of the breast cancer to utilize
estrogen. “The medication has been shown to reduce the mortality rate associated with breast
cancer.” The medication has been shown to reduce mortality rate by 14%. “The medication is
best for use in perimenopausal women.” It can be used in women with breast cancer,
regardless of menopause status. “The medication is limited to use in postmenopausal
women.” It can be used in women with breast cancer, regardless of menopause status.
16. The health care provider has fit an older adult with a pessary to manage her cystocele.
When providing information to the client, what information should be included?
1. The pessary may increase the risk for pelvic infections.
2. The pessary must be removed before sexual intercourse.
3. The pessary is hypoallergenic, eliminating the possibility of allergic reactions.
4. The pessary provides only minimal contraceptive protection.
Answer: The pessary may increase the risk for pelvic infections.
Rationale: A pessary may be used to manage displacement disorders. The insertion of a
foreign, nonsterile body into the vagina can cause an increased risk for infections. The
pessary is fit by a health care provider. It is a removable device. It may be worn during
intercourse but provides no contraceptive protection or protection from sexually transmitted
infections.
17. A couple has come to the health care provider’s office with concerns about infertility.
While collecting data, the woman questions the nurse about who is at fault for the inability to
conceive. Which of the following statements by the nurse is most appropriate at this time?
1. “The causes of infertility are varied and will require further investigation.”
2. “Most causes of infertility are never explained.”
3. “Unfortunately, infertility is usually the fault of the woman.”
4. “As long as you get pregnant, there is no need to place blame.”
Answer: “The causes of infertility are varied and will require further investigation.”
Rationale: Infertility is the inability to conceive after 12 months of appropriately timed
intercourse. Diagnostic testing and a review of the medication history will be needed to
determine the underlying cause. The cause of infertility is described as 1/3 female related, 1/3
male related, and 1/3 the result of both partners, or remains undetermined. It is too premature
to discuss pregnancy, and this particular response belittles the client’s concerns.
18. A client has reported to the emergency department with complaints of abdominal pain.
After undergoing a series of tests, the client has been diagnosed with pelvic inflammatory
disease. The client becomes tearful and asks if this disease will make her unable to have
children later. What response by the nurse is indicated?
1. “This disease is associated with infertility, but it is too early to know.”
2. “Yes, this disease will likely cause you to be infertile.”
3. “You have nothing to worry about since you are getting treatment now.”
4. “The underlying cause of the pelvic inflammatory disease will be the greatest determinant
of your potential infertility.”
Answer: “This disease is associated with infertility, but it is too early to know.”
Rationale: Pelvic inflammatory disease is associated with infertility. Infertility is not an
absolute result of pelvic inflammatory disease. The determination will be based upon the
actual damage to the reproductive organs. The infertility will be based upon the degree of
damage, not the root cause of the disorder. Telling the woman not to worry is inappropriate
and may be incorrect information.
19. A couple has been experiencing infertility for 4 years. After becoming pregnant using the
zygote intrafallopian transfer (ZIFT) procedure, the woman is diagnosed with an ectopic
pregnancy. The health care provider opts to manage the condition with methotrexate. Which
of the following is most likely the rationale for managing the condition in this manner?
1. Methotrexate will best enable the woman to retain her fertility.
2. Methotrexate will reduce the likelihood that this type of complication will occur in future
pregnancies.
3. The use of methotrexate will reduce the woman’s risk of pelvic inflammatory disease.
4. Methotrexate will reduce the risk of surgical-related adhesions.
Answer: Methotrexate will best enable the woman to retain her fertility.
Rationale: Methotrexate is a nonsurgical method to manage unruptured ectopic pregnancies.
The use of the medication can enable the condition to be treated without surgical
intervention. Methotrexate has no impact on the reduction of future ectopic pregnancies or
surgical adhesions. There is no relationship between the use of this medication and pelvic
inflammatory disease.
20. A colposcopy has been ordered for a client. Which of the following should be included in
the education provided to the client?
1. Sexual intercourse is restricted for 2 days before the procedure.
2. The procedure will likely require the client to stay overnight at the hospital.
3. Heavy vaginal bleeding is a likely occurrence after the procedure.
4. The client may expect to have referred shoulder pain in the first few days after the
procedure.
Answer: Sexual intercourse is restricted for 2 days before the procedure.
Rationale: A colposcopy refers to the collection of cervical cells. Semen can interfere with the
test results. The procedure is normally performed in the health care provider’s office;
hospitalization is not indicated with this procedure. Bleeding after the procedure is not
unusual, but it is not excessive. Referred shoulder pain may be seen with a laparoscopic
procedure, not with the colposcopy.
21. The nurse is assigned to provide care for a client who has had laparoscopy performed to
determine the extent of her endometriosis. Which of the findings in the first 4 hours after the
procedure by the nurse will indicate the need to contact the health care provider?
1. Restlessness
2. Shoulder pain
3. Brown-tinged vaginal bleeding
4. Temperature of 99.2˚F
Answer: Restlessness
Rationale: Restlessness, or any other change in the level of consciousness, may signal a
reduced oxygenation level and should be reported. Shoulder pain is expected after the
laparoscopy; it is the result of the carbon dioxide leaving the abdomen. Vaginal bleeding is
anticipated after the procedure. A temperature of 99.2˚F is not excessive and does not require
reporting at this time.
22. A 40-year-old client undergoes a total abdominal hysterectomy. After the procedure, the
patient voices an interest in hormone replacement therapy. What information should be
provided to the client?
1. Hormone replacement therapy is not indicated after this particular procedure.
2. The patient is close enough to menopause not to be a candidate for hormone replacement
therapy.
3. This client may be managed by an estrogen/progestin compound.
4. The underlying reason for the hysterectomy will be the greatest determinant for the type of
hormone replacement therapy selected.
Answer: Hormone replacement therapy is not indicated after this particular procedure.
Rationale: A total abdominal hysterectomy is the removal of the uterus and cervix. The
fallopian tubes are not removed during this procedure. Since the woman has her own ovaries,
hormone replacement therapy is not indicated, thus refuting all other options presented.
23. The nurse is providing care to a 20-year-old woman who has come to the emergency
department with reports of having been sexually assaulted a few hours ago. The victim voices
concerns about contact with the authorities. What information should be provided by the
nurse?
1. “A written consent from you will be needed to provide your personal information to the
police.”
2. “You are the victim of a crime and will need to make the report.”
3. “The police will be able to protect you from further violence.”
4. “You must agree to notification of law enforcement in order to receive referrals to support
services.”
Answer: “A written consent from you will be needed to provide your personal information to
the police.”
Rationale: Seeking treatment does not automatically allow law enforcement authorities to
have access to the client and her medical information. Some victims may be hesitant or refuse
to have law enforcement involved in the case. The refusal to participate in a legal
investigation does not limit the victim’s access to supportive or medical services. Law
enforcement is not always able to protect individuals from violence.
24. A 25-year-old woman reports to her health care provider’s office with reports of having
been sexually assaulted by an acquaintance 4 days ago. The woman is concerned about
pregnancy. What action is indicated by the nurse?
1. Advise the woman that the administration of emergency contraception is only used in the
first 72 hours after the attack.
2. Determine any potential allergies to the components of the emergency contraception pills.
3. Assess the woman’s financial resources to obtain the emergency contraception preparation.
4. Inform the woman she likely is already pregnant and will not benefit from the medication.
Answer: Advise the woman that the administration of emergency contraception is only used
in the first 72 hours after the attack.
Rationale: Emergency contraception is provided in the first 72 hours after a sexual assault;
the client has passed the window of eligibility. There is no need to assess for allergies or
financial resources to obtain the medication. Advising the woman she is already pregnant
may not be correct. In addition, the nurse is working beyond her scope of practice if she
offers this medical counseling.
25. A woman is being treated in the emergency department after being sexually assaulted.
During the collection of evidence, the nurse prepares to collect toxicology from the client.
The client questions why this is being done, as she has been the victim of an attack. What
information can the nurse provide?
1. The use of the toxicology can assess if the woman was under the influence of drugs at the
time of the assault.
2. The toxicology report will enable the authorities to determine if the woman can have a
credible recall of the events being reported.
3. The toxicology report will provide the police with information about potential exposure to
sexually transmitted infections.
4. The toxicology report can provide information as to whether the woman was drunk at the
time of the assault.
Answer: The use of the toxicology can assess if the woman was under the influence of drugs
at the time of the assault.
Rationale: The use of toxicology can determine if the client was under the influence of drugs
at the time of the assault; drugs may hinder the ability of the woman to divert or fight off an
attack. The establishment of credibility is not the motivating factor behind the collection of
toxicology samples. The presence of alcohol is determined by blood alcohol testing.
