Download Chapter 26: Female Genitourinary System and more Exams Nursing in PDF only on Docsity! Nursing Test Banks One Account Get all Test Banks Chapter 26: Female Genitourinary System Chapter 26: Female Genitourinary System Jarvis: Physical Examination & Health Assessment, 7th Edition MULTIPLE CHOICE 1. During a health history, a 22-year old woman asks, “Can I get that vaccine for human papilloma virus (HPV)? I have genital warts and I’d like them to go away!” What is the nurse’s best response? a. “The HPV vaccine is for girls and women ages 9 to 26 years, so we can start that today.” b. “This vaccine is only for girls who have not yet started to become sexually active.” c. “Let’s check with the physician to see if you are a candidate for this vaccine.” d. “The vaccine cannot protect you if you already have an HPV infection.” ANS: D The HPV vaccine is appropriate for girls and women age 9 to 26 years and is administered to prevent cervical cancer by preventing HPV infections before girls become sexually active. However, it cannot protect the woman if an HPV infection is already present. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 740 MSC: Client Needs: General 2. During an examination, the nurse observes a female patient’s vestibule and expects to see the: a. Urethral meatus and vaginal orifice. b. Vaginal orifice and vestibular (Bartholin) glands. c. Urethral meatus and paraurethral (Skene) glands. d. Paraurethral (Skene) and vestibular (Bartholin) glands. ANS: A which of these techniques to best assist the young girl in understanding the expected sequence for development? The nurse should: a. Use the Tanner scale on the five stages of sexual development. b. Describe her development and compare it with that of other girls her age. c. Use the Jacobsen table on expected development on the basis of height and weight data. d. Reassure her that her development is within normal limits and tell her not to worry about the next step. ANS: A The Tanner scale on the five stages of pubic hair development is helpful in teaching girls the expected sequence of sexual development (see Table 26-1). The other responses are not appropriate. DIF: Cognitive Level: Applying (Application) REF: p. 739 MSC: Client Needs: Health Promotion and Maintenance 6. A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart that her cervix is softened and looks cyanotic. The nurse knows that the woman is exhibiting __________ sign and __________ sign. a. Tanner; Hegar b. Hegar; Goodell c. Chadwick; Hegar d. Goodell; Chadwick ANS: D Shortly after the first missed menstrual period, the female genitalia show signs of the growing fetus. The cervix softens (Goodell sign) at 4 to 6 weeks, and the vaginal mucosa and cervix look cyanotic (Chadwick sign) at 8 to 12 weeks. These changes occur because of increased vascularity and edema of the cervix and hypertrophy and hyperplasia of the cervical glands. Hegar sign occurs when the isthmus of the uterus softens at 6 to 8 weeks. Tanner sign is not a correct response. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 739 MSC: Client Needs: Health Promotion and Maintenance 7. Generally, the changes normally associated with menopause occur because the cells in the reproductive tract are: a. Aging. b. Becoming fibrous. c. Estrogen dependent. d. Able to respond to estrogen. ANS: C Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes. The other options are not correct. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 740 MSC: Client Needs: Health Promotion and Maintenance 8. The nurse is reviewing the changes that occur with menopause. Which changes are associated with menopause? a. Uterine and ovarian atrophy, along with a thinning of the vaginal epithelium b. Ovarian atrophy, increased vaginal secretions, and increasing clitoral size c. Cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal d. Sexual history, because discussing it first will build rapport. ANS: A Menstrual history is usually nonthreatening and therefore a good topic with which to begin the interview. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start. DIF: Cognitive Level: Applying (Application) REF: p. 740 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. A patient has had three pregnancies and two live births. The nurse would record this information as grav _____, para _____, AB _____. a. 2; 2; 1 b. 3; 2; 0 c. 3; 2; 1 d. 3; 3; 1 ANS: C Gravida (grav) is the number of pregnancies. Para is the number of births. Abortions are interrupted pregnancies, including elective abortions and spontaneous miscarriages. DIF: Cognitive Level: Applying (Application) REF: p. 741 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. During the interview with a female patient, the nurse gathers data that indicate the patient is perimenopausal. Which of these statements made by this patient leads to this conclusion? a. “I have noticed that my muscles ache at night when I go to bed.” b. “I will be very happy when I can stop worrying about having a period.” c. “I have been noticing that I sweat a lot more than I used to, especially at night.” d. “I have only been pregnant twice, but both times I had breast tenderness as my first symptom.” ANS: C Hormone shifts occur during the perimenopausal period, and associated symptoms of menopause may occur, such as hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, and itching. The other responses are not correct. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 741 MSC: Client Needs: Health Promotion and Maintenance 13. A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts and wonders if these changes could be attributable to the hormone replacement therapy (HRT) she started 3 months earlier. The nurse should tell her: a. “HRT is at such a low dose that side effects are very unusual.” b. “HRT has several side effects, including fluid retention, breast tenderness, and vaginal bleeding.” c. “Vaginal bleeding with HRT is very unusual; I suggest you come into the clinic immediately to have this evaluated.” d. “It sounds as if your dose of estrogen is too high; I think you may need to decrease the amount you are taking and then call back in a week.” ANS: B MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 16. A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse should ask, “Have you noticed any: a. “Changes in your urination patterns?” b. “Excessive vaginal bleeding?” c. “Unusual vaginal discharge or itching?” d. “Changes in your desire for intercourse?” ANS: C Several medications may increase the risk of vaginitis. Broad-spectrum antibiotics alter the balance of normal flora, which may lead to the development of vaginitis. The other questions are not appropriate. DIF: Cognitive Level: Applying (Application) REF: p. 742 MSC: Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies 17. Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview? a. “Now, it is time to talk about your sexual history. When did you first have intercourse?” b. “Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?” c. “Women often have questions about their sexual relationship and how it affects their health. Do you have any questions?” d. “Most women your age have had more than one sexual partner. How many would you say you have had?” ANS: C The nurse should begin with an open-ended question to assess individual needs. The nurse should include appropriate questions as a routine part of the health history, because doing so communicates that the nurse accepts the individual’s sexual activity and believes it is important. The nurse’s comfort with the discussion prompts the patient’s interest and, possibly, relief that the topic has been introduced. The initial discussion establishes a database for comparison with any future sexual activities and provides an opportunity to screen sexual problems. DIF: Cognitive Level: Applying (Application) REF: p. 742 MSC: Client Needs: Psychosocial Integrity 18. A 22-year-old woman has been considering using oral contraceptives. As a part of her health history, the nurse should ask: a. “Do you have a history of heart murmurs?” b. “Will you be in a monogamous relationship?” c. “Have you carefully thought this choice through?” d. “If you smoke, how many cigarettes do you smoke per day?” ANS: D Oral contraceptives, together with cigarette smoking, increase the risk for cardiovascular side effects. If cigarettes are used, then the nurse should assess the patient’s smoking history. The other questions are not appropriate. DIF: Cognitive Level: Applying (Application) REF: p. 743 MSC: Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies 19. A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first? a. Ascertain whether either of them has been using broad-spectrum d. “I remember being very scared when I got my period. How do you think you’ll feel?” ANS: C Open-ended questions such as, “When did you …?” rather than “Do you …?” should be asked. Open-ended questions are less threatening because they imply that the topic is normal and unexceptional. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 743 MSC: Client Needs: Psychosocial Integrity 22. When the nurse is discussing sexuality and sexual issues with an adolescent, a permission statement helps convey that it is normal to think or feel a certain way. Which statement is the best example of a permission statement? a. “It is okay that you have become sexually active.” b. “Girls your age often have questions about sexual activity. Do you have any questions?” c. “If it is okay with you, I’d like to ask you some questions about your sexual history.” d. “Girls your age often engage in sexual activities. It is okay to tell me if you have had intercourse.” ANS: B The examiner should start with a permission statement such as, “Girls your age often experience …” A permission statement conveys the idea that it is normal to think or feel a certain way, and implying that the topic is normal and unexceptional is important. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 743 MSC: Client Needs: Psychosocial Integrity 23. The nurse is preparing to interview a postmenopausal woman. Which of these statements is true as it applies to obtaining the health history of a postmenopausal woman? a. The nurse should ask a postmenopausal woman if she has ever had vaginal bleeding. b. Once a woman reaches menopause, the nurse does not need to ask any history questions. c. The nurse should screen for monthly breast tenderness. d. Postmenopausal women are not at risk for contracting STIs; therefore, these questions can be omitted. ANS: A Postmenopausal bleeding warrants further workup and referral. The other statements are not true. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 744 MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential 24. During the examination portion of a patient’s visit, she will be in lithotomy position. Which statement reflects some things that the nurse can do to make this position more comfortable for her? a. Ask her to place her hands and arms over her head. b. Elevate her head and shoulders to maintain eye contact. c. Allow her to choose to have her feet in the stirrups or have them resting side by side on the edge of the table. d. Allow her to keep her buttocks approximately 6 inches from the edge of the table to prevent her from feeling as if she will fall off. c. Discharge that is foul smelling and irritating d. Gaping and slightly shriveled labia majora ANS: B No lesions should be noted, except for the occasional sebaceous cysts, which are yellowish 1-cm nodules that are firm, nontender, and often multiple. The labia majora are dark pink, moist, and symmetric; redness indicates inflammation or lesions. Discharge that is foul smelling and irritating may indicate infection. In the nulliparous woman, the labia majora meet in the midline, are symmetric and plump. DIF: Cognitive Level: Applying (Application) REF: p. 747 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 27. The nurse is preparing for an internal genitalia examination of a woman. Which order of the examination is correct? a. Bimanual, speculum, and rectovaginal b. Speculum, rectovaginal, and bimanual c. Speculum, bimanual, and rectovaginal d. Rectovaginal, bimanual, and speculum ANS: C The correct sequence is speculum examination, then bimanual examination after removing the speculum, and then rectovaginal examination. The examiner should change gloves before performing the rectovaginal examination to avoid spreading any possible infection. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 748 |p. 754 |p. 758 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 28. During an internal examination of a woman’s genitalia, the nurse will use which technique for proper insertion of the speculum? a. The woman is instructed to bear down, the speculum blades are opened and applied in a swift, upward movement. b. The blades of the speculum are inserted on a horizontal plane, turning them to a 30-degree angle while continuing to insert them. The woman is asked to bear down after the speculum is inserted. c. The woman is instructed to bear down, the width of the blades are horizontally turned, and the speculum is inserted downward at a 45-degree angle toward the small of the woman’s back. d. The blades are locked open by turning the thumbscrew. Once the blades are open, pressure is applied to the introitus and the blades are inserted downward at a 45-degree angle to bring the cervix into view. ANS: C The examiner should instruct the woman to bear down, turn the width of the blades horizontally, and insert the speculum at a 45-degree angle downward toward the small of the woman’s back. (See the text under “Speculum Examination” for more detail.) DIF: Cognitive Level: Applying (Application) REF: p. 749 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 29. The nurse is examining a 35-year-old female patient. During the health history, the nurse notices that she has had two term pregnancies, and both babies were delivered vaginally. During the internal examination, the nurse observes that the cervical os is a horizontal slit with some healed lacerations and that the cervix has some nabothian cysts that are small, smooth, and yellow. In addition, the nurse notices that the cervical surface is granular and red, especially around the os. Finally, the nurse notices the presence of stringy, opaque, odorless secretions. Which of these findings are abnormal? a. Nabothian cysts are present. b. Endocervical specimen, vaginal pool, and acetic acid wash c. Endocervical specimen, potassium hydroxide (KOH) preparation, and acetic acid wash d. Cervical scrape, acetic acid wash, saline mount (“wet prep”) ANS: A Laboratories may vary in method, but usually the test consists of three specimens: endocervical specimen, cervical scrape, and vaginal pool. The other tests (acetic acid wash, KOH preparation, and saline mount) are used to test for sexually transmitted infections. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 752-753 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 32. When performing the bimanual examination, the nurse notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. The nurse’s interpretation of these results should be which of these? a. These findings are all within normal limits. b. Cervical consistency should be soft and velvety—not firm. c. The cervix should move when palpated; an immobile cervix may indicate malignancy. d. Pain may occur during palpation of the cervix. ANS: C Normally, the cervix feels smooth and firm, similar to the consistency of the tip of the nose. It softens and feels velvety at 5 to 6 weeks of pregnancy (Goodell sign). The cervix should be evenly rounded. With a finger on either side, the examiner should be able to move the cervix gently from side to side, and doing so should produce no pain for the patient. Hardness of the cervix may occur with malignancy. Immobility may occur with malignancy, and pain may occur with inflammation or ectopic pregnancy. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 755 MSC: Client Needs: Health Promotion and Maintenance 33. The nurse is palpating a female patient’s adnexa. The findings include a firm, smooth uterine wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and pulsating. The nurse’s most appropriate course of action would be to: a. Tell the patient that her examination is normal. b. Give her an immediate referral to a gynecologist. c. Suggest that she return in a month for a recheck to verify the findings. d. Tell the patient that she may have an ovarian cyst that should be evaluated further. ANS: B Normally, the uterine wall feels firm and smooth, with the contour of the fundus rounded. Ovaries are not often palpable, but when they are, they normally feel smooth, firm, and almond shaped and are highly movable, sliding through the fingers. The fallopian tube is not normally palpable. No other mass or pulsation should be felt. Pulsation or palpable fallopian tube suggests ectopic pregnancy, which warrants immediate referral. DIF: Cognitive Level: Applying (Application) REF: p. 757 MSC: Client Needs: Health Promotion and Maintenance 34. A 65-year-old woman is in the office for routine gynecologic care. She had a complete hysterectomy 3 months ago after cervical cancer was detected. Which statement does the nurse know to be true regarding this visit? a. Her cervical mucosa will be red and dry looking. a. “This is a normal finding in newborns and should resolve within a few weeks.” b. “This finding could indicate an abnormality and may need to be evaluated by a physician.” c. “We will need to have estrogen levels evaluated to ensure that they are within normal limits.” d. “We will need to keep close watch over the next few days to see if the genitalia decrease in size.” ANS: A It is normal for a newborn’s genitalia to be somewhat engorged. A sanguineous vaginal discharge or leukorrhea is normal during the first few weeks because of the maternal estrogen effect. During the early weeks, the genital engorgement resolves, and the labia minora atrophy and remain small until puberty. DIF: Cognitive Level: Applying (Application) REF: p. 759 MSC: Client Needs: Health Promotion and Maintenance 37. During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which condition? a. Candidiasis b. Trichomoniasis c. Atrophic vaginitis d. Bacterial vaginosis ANS: A The woman with candidiasis often reports intense pruritus and thick white discharge. The vulva and vagina are erythematous and edematous. The discharge is usually thick, white, and curdlike. Infection with trichomoniasis causes a profuse, watery, gray-green, and frothy discharge. Bacterial vaginosis causes a profuse discharge that has a “foul, fishy, rotten” odor. Atrophic vaginitis may have a mucoid discharge. (See Table 26-5 for complete descriptions of each option.) DIF: Cognitive Level: Analyzing (Analysis) REF: p. 768 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 38. A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the nurse notices clusters of small, shallow vesicles with surrounding erythema on the labia. Inguinal lymphadenopathy present is also present. The most likely cause of these lesions is: a. Pediculosis pubis. b. Contact dermatitis. c. HPV. d. Herpes simplex virus type 2. ANS: D Herpes simplex virus type 2 exhibits clusters of small, shallow vesicles with surrounding erythema that erupt on the genital areas. Inguinal lymphadenopathy is also present. The woman reports local pain, dysuria, and fever. (See Table 26-2 for more information and the descriptions of the other conditions.) DIF: Cognitive Level: Analyzing (Analysis) REF: p. 764 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 41. During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy and fixed, with a poorly defined mass. This finding is suggestive of: a. Ovarian cyst. b. Endometriosis. c. Ovarian cancer. d. Ectopic pregnancy. ANS: C Ovarian tumors that are solid, heavy, and fixed, with poorly defined mass are suggestive of malignancy. Benign masses may feel mobile and solid. An ovarian cyst may feel smooth, round, fluctuant, mobile, and nontender. With an ectopic pregnancy, the examiner may feel a palpable, tender pelvic mass that is solid, mobile, and unilateral. Endometriosis may have masses (in various locations in the pelvic area) that are small, firm, nodular, and tender to palpation, with enlarged ovaries. DIF: Cognitive Level: Applying (Application) REF: p. 772 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 42. A 25-year-old woman comes to the emergency department with a sudden fever of 38.3° C and abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. The nurse knows that these signs and symptoms are suggestive of: a. Endometriosis. b. Uterine fibroids. c. Ectopic pregnancy. d. Pelvic inflammatory disease. ANS: D These signs and symptoms are suggestive of acute pelvic inflammatory disease, also known as acute salpingitis (see Table 26-7). (For the descriptions of endometriosis and uterine fibroids, see Table 26-6; for a description of ectopic pregnancy, see Table 26-7.) DIF: Cognitive Level: Analyzing (Analysis) REF: p. 771 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 43. During an external genitalia examination of a woman, the nurse notices several lesions around the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is not aware of any problems in that area. The nurse recognizes that these lesions may be: a. Syphilitic chancre. b. Herpes simplex virus type 2 (herpes genitalis). c. HPV or genital warts. d. Pediculosis pubis (crab lice). ANS: C HPV lesions are painless, warty growths that the woman may not notice. Lesions are pink or flesh colored, soft, pointed, moist, warty papules that occur in single or multiple cauliflower-like patches around the vulva, introitus, anus, vagina, or cervix. Herpetic lesions are painful clusters of small, shallow vesicles with surrounding erythema. Syphilitic chancres begin as a solitary silvery papule that erodes into a red, round or oval superficial ulcer with a yellowish discharge. Pediculosis pubis causes severe perineal itching and excoriations and erythematous areas (see Table 26-2). DIF: Cognitive Level: Analyzing (Analysis) REF: p. 765 c. Uterine prolapse, graded third degree. d. A normal finding. ANS: B The cervix should not be found to bulge into the vagina. Uterine prolapse is graded as follows: first degree—the cervix appears at the introitus with straining; second degree—the cervix bulges outside the introitus with straining; and third degree—the whole uterus protrudes, even without straining (essentially, the uterus is inside out). DIF: Cognitive Level: Applying (Application) REF: p. 766 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 47. A 35-year-old woman is at the clinic for a gynecologic examination. During the examination, she asks the nurse, “How often do I need to have this Pap test done?” Which reply by the nurse is correct? a. “It depends. Do you smoke?” b. “A Pap test needs to be performed annually until you are 65 years of age.” c. “If you have two consecutive normal Pap tests, then you can wait 5 years between tests.” d. “After age 30 years, if you have three consecutive normal Pap tests, then you may be screened every 2 to 3 years.” ANS: D Cervical cancer screening with the Pap test continues annually until age 30 years. After age 21, regardless of sexual history or activity, women should be screened every 3 years until age 30, then every 5 years until age 65. DIF: Cognitive Level: Applying (Application) REF: p. 741 MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. The nurse is palpating an ovarian mass during an internal examination of a 63-year-old woman. Which findings of the mass’s characteristics would suggest the presence of an ovarian cyst? Select all that apply. a. Heavy and solid b. Mobile and fluctuant c. Mobile and solid d. Fixed e. Smooth and round f. Poorly defined ANS: B, E An ovarian cyst (fluctuant ovarian mass) is usually asymptomatic and would feel like a smooth, round, fluctuant, mobile, nontender mass on the ovary. A mass that is heavy, solid, fixed, and poorly defined suggests malignancy. A benign mass may feel mobile and solid. DIF: Cognitive Level: Applying (Application) REF: p. 722 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation