Preview Extract
Chapter 6
1) The nurse is teaching a class to women who were recently diagnosed with benign breast
disease (BBD), commonly known as fibrocystic breast disease. One of the participants
reports increased swelling, pain, and pressure in her breasts just before menstruation. What is
the best response by the nurse?
1. “Consider asking your nurse practitioner about adding a mild diuretic to your regimen.”
2. “The pain may be caused by thinning of the normal breast tissue.”
3. “Breast swelling and pressure are expected symptoms, but pain is abnormal and should be
evaluated by your physician.”
4. “It's best to make an appointment with an oncologist.”
Answer: 1
Rationale 1:
Treatment of BBD may include taking a mild diuretic during the week prior to the onset of
menses to counteract fluid retention, relieve pressure in the breast, and help decrease pain.
Rationale 2:
The pathology of BBD involves fibrosis, which is a thickening of the normal breast tissue.
Rationale 3:
Common symptoms associated with BBD include cyclical breast pain, tenderness, and
swelling.
Rationale 4:
Cyclical breast pain, swelling, and tenderness are common symptoms associated with BBD.
Generally fibrocystic changes are not a risk factor for breast cancer.
2) The nurse is caring for a patient diagnosed with endometriosis. Which statement by the
patient requires immediate follow-up?
1. “I am having many hot flashes since I had the Lupron injection.”
2. “The pain I experience with intercourse is becoming more severe.”
3. “My leg has become painful and swollen since I started taking birth control pills.”
4. “I’ve noticed my voice is lower since I started taking danazol.”
Answer: 3
Rationale 1:
Leuprolide acetate (Lupron) is a GnRH agonist and causes symptoms of a hypo-estrogenic
state (hot flashes, vaginal dryness, decreased libido, and bone density loss). Hot flashes are
expected and not a complication.
Rationale 2:
Dyspareunia is a common symptom of endometriosis and therefore is not a complication.
Rationale 3:
Combination oral contraceptive pills contain estrogen. A painful, swollen lower extremity
can be a sign of deep vein thrombosis, which can cause thromboembolus, which is potentially
life threatening. This is a complication and must be addressed immediately.
Rationale 4:
Danocrine (danazol) is a testosterone derivative that suppresses GnRH and has high-androgen
and low-estrogen effects. A lowered voice is one side effect of danazol. This patient is not
experiencing a complication.
3) The nurse is creating a care plan for a patient who is unable to conceive as a consequence
of endometriosis. Which statement accurately reflects a nursing diagnosis that may apply to
the care of this patient?
1. Acute pain related to dysuria and renal pain secondary to endometriosis
2. Hyperandrogenism related to elevated serum androgen levels secondary to endometriosis
3. Compromised family coping related to depression secondary to infertility
4. Infertility related to endometrial inflammation and adhesions secondary to endometriosis
Answer: 3
Rationale 1:
Pelvic pain is a frequent symptom of endometriosis, while dysuria and renal pain are more
commonly associated with conditions such as upper urinary tract infections (UTI).
Rationale 2:
Hyperandrogenism is a medical diagnosis that pertains to elevated serum androgen levels.
Hyperandrogenism is associated with polycystic ovarian syndrome (PCOS).
Rationale 3:
Infertility may lead to depression and subsequent compromised family coping, which is a
nursing diagnosis.
Rationale 4:
Although associated with the medical condition of endometriosis, infertility is a medical
diagnosis.
4) The patient has been diagnosed with endometriosis. She asks the nurse if there are any
long-term health risks associated with this condition. The nurse should include which
statement in the patient teaching about endometriosis?
1. “There are no other health risks associated with endometriosis.”
2. “Pain with intercourse rarely occurs as a long-term problem.”
3. “You are at increased risk for ovarian and breast cancer.”
4. “Most women with this condition develop fibromyalgia.”
Answer: 3
Rationale 1:
There are long-term health risks associated with endometriosis, including increased risk for
cancer of the ovary and breast, melanoma, non-Hodgkins lymphoma, and an increased
incidence of fibromyalgia.
Rationale 2:
Dyspareunia is a common symptom of endometriosis.
Rationale 3:
An increased risk for cancer of the ovary and breast is associated with endometriosis.
Rationale 4:
There is a risk of increased incidence of fibromyalgia.
5) A patient diagnosed with polycystic ovarian disease (PCOS) asks her nurse why her
treatment regimen includes spironolactone (Aldactone). How should the nurse respond?
1. "Spironolactone may be used to decrease symptoms associated with PCOS, such as
excessive hair growth and acne."
2. "Menstrual irregularities related to polycystic ovarian disease are treated using
spironolactone."
3. "Spironolactone is often used to reduce complications associated with PCOS, including
rectocele."
4. "Condylomata acuminata, which are sometimes caused by polycystic ovarian disease, are
treated with spironolactone."
Answer: 1
Rationale 1:
Spironolactone may be used to treat symptoms of hyperandrogenism that are secondary to
PCOS, including excessive hair growth and acne.
Rationale 2:
Combined oral contraceptive (COC) or cyclic progesterone are used to treat menstrual
irregularities associated with PCOS.
Rationale 3:
A rectocele, which may develop when the posterior vaginal wall is weakened, is associated
with pelvic relaxation.
Rationale 4:
Condylomata acuminata, also called genital or venereal warts, is a sexually transmitted
condition unrelated to PCOS.
6) The nurse is planning a group session for parents who are beginning infertility evaluation.
Which statement should be included in this session?
1. “Infertility can be stressful for a marriage.”
2. “The doctor will be able to tell why you have not conceived.”
3. “Your insurance will pay for the infertility treatments.”
4. “Keep communicating with one another through this process.”
5. “Taking a vacation usually results in pregnancy.”
Answer: 1,4
Rationale 1:
Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and
pay for treatments and the societal expectation to have children.
Rationale 2:
Some infertility cannot be explained, despite extensive treatments.
Rationale 3:
Insurance often does not pay for infertility treatment.
Rationale 4:
Communication is important to help cope with stress. A nurse should always encourage
patients to ask questions.
Rationale 5:
A common myth is that taking a vacation or just relaxing will result in conception.
7) Which patient in the gynecology clinic should the nurse see first?
1. 22-year-old, using tampons, T=102°F, P=122, BP=70/55
2. 15-year-old, no menses for past four months
3. 18-year-old seeking information on contraception methods
4. 31-year-old, reports increasing dyspareunia
Answer: 1
Rationale 1:
A patient using tampons who is febrile, tachycardic, and hypotensive might have toxic shock
syndrome. Hypotension is life-threatening; this patient should be seen immediately.
Rationale 2:
Secondary amenorrhea can be caused by pregnancy. Teen pregnancy is a high risk, but no
indication is given that the patient is exhibiting a life-threatening condition.
Rationale 3:
Unplanned pregnancy and sexually transmitted infections can be problematic in the future,
but this patient exhibits no signs or symptoms of a life-threatening condition at this time.
Rationale 4:
Although this patient might have endometriosis, dyspareunia is not a life-threatening
condition.
8) Which statement indicates that patient teaching has been effective?
1. “I should douche weekly to prevent a recurrence of my bacterial vaginosis.”
2. “I can use this anti-yeast medication weekly to prevent another infection.”
3. “My diabetes is unrelated to the frequency of my vaginal yeast infections.”
4. “The fishy vaginal odor I have is caused by a bacterial infection.”
Answer: 4
Rationale 1:
Douching disrupts normal flora by washing out desirable bacteria; douching is not
recommended.
Rationale 2:
Medication for vaginal yeast infections should be used as treatment, not prophylaxis. Using
medication as prescribed is important patient education. Medication should not be saved for
future use.
Rationale 3:
Yeast vaginitis is more common in diabetic and pre-diabetic women. Four episodes or more
per year of yeast vaginitis are an indication to screen a woman for diabetes.
Rationale 4:
Bacterial vaginosis is characterized by a fishy vaginal odor and greenish discharge with a
vaginal pH over 4.5.
9) Which patient is at greatest risk for developing Chlamydia trachomatis infection?
1. 16-year-old, sexually active, using no contraceptive
2. 22-year-old mother of two, developed dyspareunia
3. 35-year-old woman on oral contraceptives
4. 48-year-old woman with hot flashes and night sweats
Answer: 1
Rationale 1:
Teens have the highest incidence of sexually transmitted infections, especially Chlamydia. A
patient not using contraceptives is not using condoms, which decrease the risk of contracting
a STI.
Rationale 2:
Dyspareunia sometimes develops with Chlamydia infection, but dyspareunia is not a
symptom specific to Chlamydia.
Rationale 3:
There is no correlation between oral contraceptive use and an increased rate of Chlamydia
infection. Additionally, Chlamydia is more commonly seen in young women
Rationale 4:
This patient is experiencing signs of menopause, not Chlamydia infection.
10) The physician has prescribed metronidazole (Flagyl) for a woman diagnosed with
trichomoniasis. The nurse’s instructions to the woman should include:
1. “Both partners must be treated with the medication.”
2. “Alcohol does not need to be avoided while taking this medication.”
3. “It will turn your urine orange.”
4. “This medication could produce drowsiness.”
Answer: 1
Rationale 1:
Both partners should be treated with the medication.
Rationale 2:
Alcohol should be avoided.
Rationale 3:
Metronidazole does not turn the urine orange.
Rationale 4:
Metronidazole does not cause drowsiness.
11) The couple demonstrates understanding of the consequences of not treating Chlamydia
when they state:
1. “She could become pregnant.”
2. “She could have severe vaginal itching.”
3. “He could get an infection in the tube that carries the urine out.”
4. “It could cause us to develop rashes.”
5. “She could develop a worse infection of the uterus and tubes.”
Answer: 3,5
Rationale 1:
Chlamydia does not cause a woman to become pregnant.
Rationale 2:
Chlamydia does not cause vaginal itching.
Rationale 3:
Chlamydia is a major cause of nongonococcal urethritis (NGU) in men.
Rationale 4:
Chlamydia does not cause a rash.
Rationale 5:
Chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the
uterus, fallopian tubes, and sometimes ovaries.
12) Which of the following patients should be treated with ceftriaxone (Rocephin) IM and
doxycycline (Vibramycin) orally?
1. A pregnant patient with gonorrhea and a yeast infection
2. A non-pregnant patient with gonorrhea and Chlamydia
3. A pregnant patient with syphilis
4. A non-pregnant patient with Chlamydia and trichomoniasis
Answer: 2
Rationale 1:
Doxycycline is contraindicated during pregnancy.
Rationale 2:
This combined treatment provides dual treatment for gonorrhea and Chlamydia because the
two infections frequently occur together.
Rationale 3:
Syphilis is treated with penicillin.
Rationale 4:
Trichomoniasis is treated with metronidazole.
13) The nurse is preparing a brochure that compares and contrasts cystitis and pyelonephritis.
Which information should be included in the brochure?
1. Both conditions usually present with sudden onset of chills, high temperature, and flank
pain.
2. Dysuria, especially at the end of urination, is often the initial symptom of both conditions.
3. Both conditions are associated with pregnancy complications including increased risk of
preterm birth and of intrauterine growth restriction.
4. Urine culture is included in the evaluation of both cystitis and pyelonephritis.
Answer: 4
Rationale 1:
Acute pyelonephritis has a sudden onset, with chills, high temperature, and flank pain (either
unilateral or bilateral).
Rationale 2:
The initial symptom of cystitis is often dysuria, specifically at the end of urination.
Rationale 3:
Pyelonephritis during pregnancy is associated with an increased risk of preterm birth and
intrauterine growth restriction.
Rationale 4:
Diagnosis of cystitis is made with a urine culture. Women with acute pyelonephritis should
have a urine culture and sensitivity done to determine the appropriate antibiotic.
14) The nurse is discharging a patient after hospitalization for pelvic inflammatory disease
(PID). Which statements indicate that teaching was effective?
1. “I might have infertility because of this infection.”
2. “It is important for me to finish my antibiotics.”
3. “Tubal pregnancy could occur after PID.”
4. “My PID was caused by a yeast infection.”
5. “I am going to have an IUD placed for contraception.”
Answer: 1,2,3
Rationale 1:
Women sometimes become infertile because of scarring in the fallopian tubes as a result of
the inflammation of PID.
Rationale 2:
Antibiotic therapy should always be completed when a patient is diagnosed with any
infection.
Rationale 3:
The tubal scarring that occurs from tubal inflammation during PID can prevent a fertilized
ovum from passing through the tube into the uterus, causing an ectopic or tubal pregnancy.
Rationale 4:
PID is caused by bacteria, most commonly Chlamydia trachomatis or Neisseria gonorrhoeae.
Yeast infections do not ascend and become upper reproductive tract infections.
Rationale 5:
An intrauterine device (IUD) in place increases the risk of developing PID; a patient who has
a history of PID is not a good candidate for an IUD.
15) Which of the following diagnostic tests would the nurse question when ordered for a
patient diagnosed with pelvic inflammatory disease (PID)?
1. CBC (complete blood count) with differential
2. Vaginal culture for Neisseria gonorrhoeae
3. Throat culture for Streptococcus A
4. RPR (rapid plasma reagin)
Answer: 3
Rationale 1:
CBC with differential will give an indication of the severity of the infection.
Rationale 2:
Gonorrhea is a common cause of PID, and the patient should be tested for this.
Rationale 3:
Streptococcus of the throat is not associated with PID.
Rationale 4:
RPR is a test for syphilis, another cause of PID.
16) The nurse is to tell a patient that her Pap smear result was abnormal. Which statement
should the nurse include?
1. “The Pap smear is used to diagnose cervical cancer.”
2. “A loop electrosurgical excision procedure (LEEP) is needed.”
3. “Colposcopy to further examine your cervix is the next step.”
4. “Your cervix needs to be treated with cryotherapy.”
Answer: 3
Rationale 1:
The Pap smear is a screening tool for cervical abnormalities; it is not diagnostic.
Rationale 2:
Although LEEP (the removal of the surface tissue of the cervix) might be performed to treat
cervical dysplasia or carcinoma in situ, this patient has not had a diagnostic examination yet.
Rationale 3:
Colposcopy is an examination of the cervix through a magnifying device. Solutions are often
painted onto the cervix and surrounding tissue and observed for changes secondary to the
application of the solution. Biopsy samples are taken of suspected abnormal tissue and sent
for pathologic examination and diagnosis. Endocervical canal biopsy is often undertaken with
colposcopy.
Rationale 4:
Cryotherapy, or freezing of the cervix, is one treatment option for precancerous cervical
lesions. However, this patient does not yet have a diagnosis; she has only had an abnormal
screening test.
17) The nurse is preparing an education session for women on prevention of urinary tract
infections (UTIs). Which statement should be included?
1. Lower urinary tract infections rarely occur in women.
2. The most common causative organism of cystitis is E. coli.
3. Wiping from back to front after a BM will help prevent a UTI.
4. Back pain often develops with a lower urinary tract infection.
Answer: 2
Rationale 1:
About 60% of women will experience an episode of cystitis during their lifetime.
Rationale 2:
Because E. coli is a common bacterium in the bowel and the female urethra is short and close
to the anus, cross-contamination of bowel bacteria into the female urinary tract is common.
Rationale 3:
Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being
drawn towards the urethra. Women should be instructed always to wipe from front to back.
Rationale 4:
Low back or flank pain is a sign of pylonephritis, which is an upper urinary tract infection.
Signs of a lower UTI include dysuria, urinary frequency, and urinary urgency.
18) The nurse is caring for a patient who underwent a total abdominal hysterectomy with
bilateral salpingo-oophorectomy several hours ago. The highest priority for the nurse is to:
1. Monitor blood pressure and pulse.
2. Assess the patient’s acceptance of not being able to have children.
3. Teach the patient how to splint her abdomen while taking deep breaths.
4. Verify that the IV pump is working correctly.
Answer: 1
Rationale 1:
A post-surgical patient is at risk for internal bleeding at the site of the surgery. Monitoring
blood pressure and pulse is necessary to verify that the patient is hemodynamically stable.
Rationale 2:
Although this patient will not be able to become pregnant because of the surgery, acceptance
is a psychosocial issue and a lower priority than is physiologic stability.
Rationale 3:
Splinting while deep-breathing is a comfort measure to facilitate oxygenation and prevent
atelectasis. But hemodynamic stability is a higher priority.
Rationale 4:
The patient needs IV fluids to replace blood loss during surgery and until oral intake is
adequate. But hemodynamic stability is a higher priority.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
