Preview Extract
Chapter 5
1) The clinic nurse is returning phone calls. Which call should the nurse return first?
1. 22-year-old reporting that she has menstrual cramps and vomiting every month
2. 17-year-old asking if there is a problem with using one tampon for a whole day
3. 46-year-old mother of a teen wondering if her daughter should be on birth control
4. 34-year-old requesting information on douching after intercourse
Answer: 2
Rationale 1:
Because vomiting can lead to dehydration, this patient will require further assessment.
Because her symptoms are not life-threatening, this patient’s assessment is not the first
priority.
Rationale 2:
Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially lifethreatening condition. This patient needs education on the danger of using one tampon more
than 3–6 hours.
Rationale 3:
A sexually active teen could be at risk for unintended pregnancy, as well as sexually
transmitted infections. However, it is unclear whether the daughter is sexually active. This
call is a low priority.
Rationale 4:
Douching is not recommended, because the practice causes a change in the pH of the vagina
and impacts the normal flora, predisposing patients to candidiasis and bacterial vaginosis.
This patient requires education but is not the first priority.
2) When taking a sexual history from a patient, the nurse should:
1. Ask questions that the patient can answer with a “yes” or “no.”
2. Ask mostly open-ended questions.
3. Have the patient fill out a comprehensive questionnaire and review it after the patient
leaves.
4. Try not to make much direct eye contact.
Answer: 2
Rationale 1:
“Yes-or-no” answers indicate closed-ended questions that will not encourage the patient to
share the necessary information.
Rationale 2:
Open-ended questions are often useful in eliciting information because they encourage more
than a one-word answer.
Rationale 3:
Filling out a questionnaire and reviewing it after the patient leaves is not appropriate. It
should be reviewed in the presence of the patient, encouraging conversation regarding the
results.
Rationale 4:
It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Eye
contact encourages a connection between the involved parties and shows care and concern.
3) Which patient would the nurse document as exhibiting signs and symptoms of primary
dysmenorrhea?
1. 17-year-old, has never had a menstrual cycle
2. 16-year-old, had regular menses for 4 years, but has had no menses in four months
3. 19-year-old, regular menses for 5 years that have suddenly become painful
4. 14-year-old, irregular menses for one year, experiences cramping every cycle
Answer: 4
Rationale 1:
This is primary amenorrhea, or the lack of menses.
Rationale 2:
Secondary amenorrhea is the term used when a patient has had regular cycles that cease.
Rationale 3:
Secondary dysmenorrheal is the sudden onset of pain and discomfort with menses.
Rationale 4:
Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle
and consistently continues to be painful each month.
4) A patient asks her nurse, "Is it okay for me to use a vaginal douche each day when I'm on
my period?" The nurse's correct response is:
1. "Douching should be avoided when you're on your period."
2. "Using a douche each day will help prevent vaginal infections from occurring."
3. "During your period, douching will help promote the flow of menstrual secretions."
4. "Regular douching is necessary in order to promote good hygiene."
Answer: 1
Rationale 1:
Women should avoid douching during menstruation because the cervix is dilated to permit
the downward flow of menstrual fluids from the uterine lining.
Rationale 2:
Douching washes away the natural mucus and upsets the vaginal flora, which can make the
vagina more susceptible to infection.
Rationale 3:
During menstruation, douching may interfere with downward flow of menstrual fluids from
the uterine lining.
Rationale 4:
Douching as a hygiene practice is unnecessary because the vagina cleanses itself.
5) What should the gynecology clinic nurse recommend for the patient experiencing
premenstrual syndrome?
1. “Eat more chocolate and drink more caffeine beginning a week prior to when your
menstrual cycle bleeding should begin.”
2. “Engage in aerobic activity often throughout the month, and continue exercising when
your symptoms begin.”
3. “Decrease your dietary intake of dairy and soy slightly during the month, and especially
during your days of bleeding.”
4. “Increase your consumption of red meat when you feel symptoms, and eat three large
meals per day.”
Answer: 2
Rationale 1:
Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and
colas should be limited throughout the month.
Rationale 2:
Regular aerobic activity helps to decrease PMS symptoms.
Rationale 3:
1,200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come
from supplements or be obtained through dietary intake of dairy and soy products.
Rationale 4:
Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating
several small meals per day rather than three large meals.
6) A patient comes to the clinic complaining of severe menstrual cramps. She has never been
pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for
two years. The most likely cause for the patient’s complaint is:
1. Primary dysmenorrhea.
2. Secondary dysmenorrhea.
3. Menorrhagia.
4. Hypermenorrhea.
Answer: 2
Rationale 1:
Primary dysmenorrhea is defined as cramps without underlying disease.
Rationale 2:
Secondary dysmenorrhea is associated with pathology of the reproductive tract and usually
appears after menstruation has been established. Conditions that most frequently cause
secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device.
Rationale 3:
Menorrhagia is excessive, profuse flow.
Rationale 4:
Hypermenorrhea is an abnormally long menstrual flow.
7) Which issues should the nurse consider when counseling a patient on contraceptive
methods?
1. Cultural perspectives on menstruation and pregnancy
2. Efficacy of the method
3. Future childbearing plans
4. Whether the patient is a vegetarian
5. Age at menarche
Answer: 1,2,3
Rationale 1:
Cultural and religious beliefs, practices, and sanctions must be considered when discussing
contraception with patients in order to avoid insulting a patient for whom a particular type of
contraceptive method is prohibited by her background.
Rationale 2:
Efficacy of contraceptive methods varies and must be considered when discussing
contraception with patients. When pregnancy is medically contraindicated, high-efficacy
methods (such as an IUD, hormonal methods, or sterilization) should be discussed with the
patient. When the patient would like to avoid pregnancy at this time, but pregnancy is not
medically contraindicated, lower-efficacy methods (such as diaphragm, cervical cap, or
Today sponge) could be discussed.
Rationale 3:
If a patient desires children in the future, sterilization methods would be inappropriate to
discuss.
Rationale 4:
Vegetarianism has no impact on contraceptive method use.
Rationale 5:
Age at menarche has no impact on contraceptive method use.
8) A patient has decided to use the NuvaRing vaginal contraceptive ring as her method of
contraception. Which statement suggests the patient needs further instruction?
1. "I do not need to be examined in order to determine the contraceptive ring size that is
correct for me."
2. "Every three months, I will need to remove the contraceptive ring and replace it with a new
one."
3. "When I store my replacement rings, I should keep them in my refrigerator."
4. "The contraceptive ring provides a sustained release of low-dose contraceptive."
Answer: 2
Rationale 1:
One size of the NuvaRing fits virtually all women.
Rationale 2:
The ring is left in place for 3 weeks and then removed for 1 week to allow for withdrawal
bleeding.
Rationale 3:
Replacement rings should be kept in the refrigerator to maintain integrity.
Rationale 4:
The contraceptive ring provides a low-dose, sustained-release hormonal contraceptive.
9) Which patient is not a good candidate for Depo-Provera (DMPA)?
1. One who wishes to get pregnant within three months
2. One who wishes to breastfeed
3. One with a vaginal prolapse
4. One who weighs 200 pounds
Answer: 1
Rationale 1:
Return of fertility after the use of Depo-Provera takes an average of nine months.
Rationale 2:
Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera.
Rationale 3:
There is no correlation between a vaginal prolapse and use of Depo-Provera.
Rationale 4:
There is no correlation between one’s weight and use of Depo-Provera.
10) The Public Health Nurse receives a phone call from a 16-year-old girl who asks, "Do I
need to have a Pap smear just because I'm sexually active?" What is the nurse's correct
response?
1. "Yes, all sexually active females should be screened for both cervical cancer and HPV.”
2. "No, you do not need to be screened for cervical cancer until you are 21 years old."
3. "Yes, all women under the age of 29 should be screened for both cervical cancer and
HPV."
4. "No, but you will need to begin your screenings for both cervical cancer and HPV when
you are 18 years old."
Answer: 2
Rationale 1:
Engaging in sexual activity is not an indication for routine cervical cancer or for HPV
screening.
Rationale 2:
2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend
initiating cervical cancer screening at age 21.
Rationale 3:
2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend
cervical cancer screening without HPV co-testing in women ages 21 to 29.
Rationale 4:
2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend
initiating cervical cancer screening at age 21.
11) A nurse is providing a patient with instructions regarding breast self-examination (BSE).
Which of the following statements by the patient would indicate the likelihood that she
understands how to detect changes such as lumps in her breast?
1. “I should perform BSE one week prior to the start of my period.”
2. “When I reach menopause, I will perform BSE every two months.”
3. “Knowing the texture and feel of my breasts is important.”
4. “I should inspect my breasts in a circular manner.”
5. “I should inspect my breasts while in a supine position, with my arms at my sides.”
Answer: 3,4
Rationale 1:
BSE should be performed one week after the start of each menstrual period because hormonal
levels are lowest and allow closer exam of softer breast tissue.
Rationale 2:
BSE should be performed monthly, on the same day each month, during menopause.
Rationale 3:
A woman who knows the texture and feel of her own breasts is far more likely to detect
changes that develop.
Rationale 4:
Checking breasts in a circular manner, feeling all parts of the breast, provides adequate
palpation and possible detection of lumps.
Rationale 5: The breasts should be inspected while standing with arms at sides.
12) What is the best indicator that the patient is experiencing menopause?
1. No menses for 8 consecutive months
2. Hot flashes and night sweats
3. High serum FSH with low serum estrogen
4. Diagnosed with osteoporosis 4 months ago
Answer: 3
Rationale 1:
Menopause is defined as 12 months of amenorrhea.
Rationale 2:
Although hot flashes and night sweats are common in menopause, lab values or twelve
months of amenorrhea are better indicators.
Rationale 3:
Examining serum levels of the hormones FSH and estrogen is a very accurate indication of
menopause.
Rationale 4:
Menopause is not the only cause of osteoporosis; therefore, the diagnosis of osteoporosis 4
months ago is not an indicator of menopause.
13) A 63-year-old female patient requests information about complementary and alternative
therapies that promote wellness during menopause. Which therapies should the nurse
recommend?
1. Non-weight-bearing exercise, such as swimming.
2. Increased consumption of phytoestrogens (i.e., plant products with estrogen properties) for
women with a history of endometeriosis or fibroids.
3. Calcium intake of 600 mg per day to help prevent osteoporosis.
4. Soy for reducing insomnia symptoms.
Answer: 4
Rationale 1:
Weight-bearing exercises such as walking, jogging, tennis, and low-impact aerobics are
encouraged in order to increase bone mass and decrease the risk of osteoporosis.
Rationale 2:
Women who have endometriosis or fibroids should be cautioned on the use of phytoestrogens
Rationale 3:
Peri- and postmenopausal women are advised to have a calcium intake of at least 1200 mg
per day. Most women require supplements to achieve this level.
Rationale 4:
Research suggests that isoflavones, which are found in soy, are effective in reducing
symptoms of insomnia in postmenopausal women.
14) The nurse is presenting a session on intimate partner violence. Which statement indicates
a need for further education?
1. “My daughter is not to blame for the violence in her marriage.”
2. “Everyone experiences anger and hitting in a relationship.”
3. “Abusers can be either husbands or boyfriends or girlfriends.”
4. “The ‘honeymoon period’ follows an episode of violence.”
Answer: 2
Rationale 1:
The victims of violence are not the cause of the violence. Abusers are responsible for their
violent behavior. Avoiding blaming and shaming of victims of domestic violence is important
to establish a therapeutic relationship.
Rationale 2:
Violence is not a normal part of intimate relationships. This statement indicates that the
patient has likely been a victim of domestic violence.
Rationale 3:
Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be
experienced in any intimate relationship, regardless of whether the couple is straight, gay, or
lesbian, and both within marriage and outside of marriage.
Rationale 4:
An acute episode of battering is followed by the tranquil phase, or honeymoon period, when
the abuser is often repentant and promising never to abuse the victim again. In some cases,
the honeymoon period is the only time there is a lack of building tension.
15) When a woman who has been raped is admitted to the emergency department, which
nursing intervention has priority?
1. Explain exactly what will need to be done to preserve legal evidence.
2. Assure the woman that everything will be all right.
3. Create a safe, secure atmosphere for the woman.
4. Contact family members.
Answer: 3
Rationale 1:
Explaining exactly what will need to be done to preserve legal evidence is not the top
priority.
Rationale 2:
Assuring the woman that everything will be all right is not the top priority and is giving false
promise.
Rationale 3:
The first priority in caring for a survivor of a sexual assault is to create a safe, secure
atmosphere that will allow the woman to process what has happened.
Rationale 4:
Contacting family members is not the top priority and can wait until a safe environment is
established.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
