Health Care Professions and Specialties, Exams of Nursing

Download Health Care Professions and Specialties and more Exams Nursing in PDF only on Docsity! 1 Women’s Health A Primary Care Clinical Guide 5th Edition Youngkin Schadewald Pritham Test Bank Chapter 1 Access to Women’s Health Care in the United States: Affordability, Equity, Rights 1. Which health occupation has the highest percentage of women? A. Pharmacists B. Physical therapists C. Registered nurses D. Dental hygienists Answer: D 2. Which health occupation has the lowest percentage of women? A. Physicians B. Dentists C. Pharmacists D. Physical therapists Answer: B 3. Which health profession has the largest number of workers? A. Health aides B. Physicians C. Licensed practical nurses D. Registered nurses Answer: D 4. Which of the following are certifications available in advanced practice registered nursing? (Select all that apply.) A. Certified nurse midwife B. Certified registered nurse anesthetist C. Certified nurse pharmacologist D. Clinical nurse specialist E. Nurse practitioner Answer: A, B, D, E 5. What level of education is required to become a licensed practical nurse? A. 2-year master’s degree (in addition to a 4-year bachelor’s degree) B. 4-year bachelor’s degree C. 2-year associate’s degree D. 1-year certificate or diploma Answer: D 6. What percentage of physicians and surgeons in the United States in 2014 were women? A. 27% B. 37% C. 47% D. 57% Answer: B 7. What medical specialty has the highest percentage of women? A. General pediatrics B. Obstetrics and gynecology C. Orthopedic surgery D. Urology 2 C. Sharing of racist jokes D. Lower pay for racial minorities Answer: A Chapter 2 Women’s Development into the 21st Century 1. To enhance women’s health care in the 21st century, researchers should do which of the following? (Select all that apply.) A. Design studies in collaboration with women B. Analyze changes in women’s health data relative to men’s C. Include homogeneous populations of women in studies D. Translate research findings into clinical and public health practice E. Focus on treatment approaches equally applicable to men and women Answer: A, B, D 2. Historically, gender has been defined by which of the following? (Select all that apply.) A. Self-identification B. Appropriate roles C. Division of labor D. Economic power E. Political influence Answer: B, C, D, E 3. Hammarstrӧm et al. propose a model of sex and gender that includes which of the following concepts? (Select all that apply.) A. Binary sexuality based on one’s chromosomes B. Sex, interacting with gender, as a continuum 5 6 C. Biologically determined sex based on the effects of sex hormones on reproductive organ development D. Sex and gender as an integration of body, mind, and context E. Intersectionality and embodiment as factors significantly affecting sex and gender Answer: B, D, E 4. Which of the following is the best example of how gender bias has affected the health and health care of women? A. Similar rates of mental illness being found in men and women B. Treatment outcomes among women varying based on patient compliance C. Association of patient income level with type of diagnosis D. Disproportionately more psychotropic medications being prescribed to women than men Answer: D 5. Krieger has proposed which of the following regarding sex, gender, and health? (Select all that apply.) A. Gender and sex played no significant role in determining health outcomes for women B. Gender relations influence the expression and the interpretation of biological traits C. Sex-linked biological characteristics contribute to gender differentials in health D. Traditional perspectives on gender and sex have resulted in better health outcomes for women than for men E. Equitable gender relationships have resulted in similar health outcomes in men and women Answer: B, C 6. When did women’s health scholarship begin to flourish? A. 1960s B. 1970s C. 1980s D. 1990s Answer: B 7. Which of the following were the goals included in the report “Women’s Health Research: Progress, Pitfalls, and Promise,” which was published by the Office of Research on Women’s Health in 2010? (Select all that apply.) A. Increase sex similarities research in basic sciences studies B. Incorporate findings of sex and gender differences in the design of new technologies C. Create strategic alliances to maximize domestic and global impact of women’s health research D. Develop and implement new social networking technologies to promote men’s health and wellness research E. Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce Answer: B, C, E 8. The National Institutes of Health (NIH) Revitalization Act of 1993 mandated that the NIH do which of the following? A. Expand health insurance coverage for women B. Include women and minorities in clinical research C. Research and develop new women-specific medications D. Decrease infection rates during obstetric surgeries Answer: B 9. Historical examples of gender bias in medical textbooks include which of the following? (Select all that apply.) 7 Abnormal Pap smear c: Abnormal bleeding d: Recurrent cystitis 8: A 32-year-old patient recovering from a gynecologic procedure complains of shoulder pain. The procedure she had was most likely a(n) a: LEEP b: cervical biopsy c: endometrial ablation d: dilation and curettage e: laparoscopy 9: What is the most appropriate initial imaging study in an asymptomatic patient with 18-week-size fibroids? a: Positron emission tomography (PET) b: computed tomography (CT) c: Transabdominal ultrasonography d: Sonohysterography e: Magnetic resonance imaging (MRI) 10: A 20-year-old patient at 6 weeks of gestation is suspected of having an ovarian neoplasm. The most appropriate initial imaging technique is a: Computed tomography (CT) b: Positron emission tomography (PET) c: transvaginal ultrasonography d: transabdominal ultrasonography e: Magnetic resonance imaging (MRI) 11: A healthy, asymptomatic, nulliparous 36-year-old woman requests your advice because she has been unsuccessful at achieving pregnancy over the last 13 months, despite regular menses. Performing an 10 11 initial physical examination, you detect a firm, non-tender, multinodular uterus whose size corresponds to that at approximately 8 to 10 weeks of pregnancy, which is consistent with leiomyomata uteri. The remainder of the medical history and physical examination is within normal limits, as is her husband's semen analysis. Normal ovulatory status has been documented by basal body temperature monitoring and luteal-phase progesterone measurement. Your next best step is to recommend a: normal pelvic ultrasonography b: hysterosalpingogram (HSG) c: in vitro fertilization - embryo transfer (IVF- ET) d: myomectomy e: arterial embolization of the fibroids 12: A 36-year-old woman with regular, monthly, 5-day menstrual cycles presents with a 2-year history of severe right-sided pelvic pain. Pelvic examination reveals no abnormalities. She reports insomnia, loss of appetite, and decreased libido. The patient once considered evaluation for infertility but now does not desire childbearing. She has had three laparoscopic procedures in the last 18 months that showed minmal peritoneal adhesions, with no change in the pain. Appropriate management of this includes a: repeat diagnostic laparoscopy b: barium enema, intravenous pyelography, and plevic ultrasonography c: presacral neurectomy d: transabdominal hysterectomy and bilateral salpingo-oophorectomy e: psychological counseling with antidepressant therapy 13: A 63-year-old woman with 6 months of early satiety and increased abdominal girth has an abdominal fluid wave and a palpable 12 cm nodular right adnexal mass. The next BEST step would be for her to obtain a: a diagnostic laparoscopy b: a staging laparotomy and debulking for her presumed ovarian cancer c: a CT scan to get the exact dimensions of the mass d: chemotherapy e: an ultrasonography to determine if the mass is cystic or solid 14: A 42-year-old woman, G2P2, who had a laparoscopic tubal fulguration 7 years ago, has abnormal uterine bleeding. Her menstrual cycle has been 28-30 days with a menstrual flow of 5-6 days. During the last 6 months, the interval has varied from 14 to 35 days and the menstrual flow has lasted from 1 to 14 days. The uterus is irregular and firm and consistent in size with an 8-week gestation. Both ovaries are palpably normal in size. Urine pregnancy test is negative. The most appropriate next step in management is a: endometrial sampling b: laparoscopy c: transabdominal ultrasonography d: pelvic CT e: hysteroscopy 15: A 19-year-old primigravid woman is seen because of vaginal bleeding. Her LMP was about 11 weeks ago; the vagina contains a small amount of dark blood and the cervix is long and closed. The uterus is enlarged and not tender. A pelvic ultrasonography demonstrates an intrauterine gestational sac but no fetal pole is identified. The patient is distraught but declines surgical management. Of the following, the most appropriate management of this patient's condition is a: combination oral contraceptive pills b: methotrexate intramuscular injection c: depot medroxyprogesterone acetate d: oral broad-spectrum antibiotic thearpy e: mifepristone pills and vaginal misoprostol ANS: [cddbc eaecc beaae] 12 of experiencing 15 which of the following? (Select all that apply.) A. Obesity B. Family violence C. Homelessness D. Substance abuse E. Suicidality Answer: B, C, D, E 8. Rose is a 14-year-old refugee from Nigeria who recently came to the United States. Being a foreign born, which of the following is Rose more likely to do than her native-born classmates? A. Exercise B. Succeed academically C. Eat meals with her family D. Develop positive peer relationships Answer: C 9. Destiny is an outgoing, fun-loving 13-year-old who has developed a strong network of friends at school. These positive relationships make it more likely that Destiny will experience which of the following? (Select all that apply.) A. Academic achievement B. A healthy diet C. Reduced substance abuse D. Improved mental health E. Lack of peer conflict Answer: A, C, 16 D 17 20 Chapter 5 Assessing Adult Women’s Health Diane Marie Schadewald, Catherine Juve, Ellis Quinn Youngkin, Marcia Szmania Davis 1. Midlife is commonly defined by which of the following ways? (Select all that apply.) A. Age B. Proximity to menopause C. Degree of children’s independence D. Level of cognitive function E. Women’s self-perception of age Answer: A, B, C, E 2. Vivian is an 80-year-old patient who is reminiscing about her own midlife with her nurse, who has just entered midlife. Given her age, Vivian is most likely to identify which of the following as having been a primary source of meaning during her midlife? A. Her career B. Her family C. Her friends D. Her artistic accomplishments Answer: B 3. Which of the following is the definition of menopause currently used in the health sciences? A. The date of onset of menopause-related symptoms B. The cessation of menses, defined as the end of the final menstrual period C. The cessation of menses, defined as 1 year after the final menstrual period D. The date of the last menopause-related symptom Answer: C 4. Women of which U.S. ethnic group are most likely to describe menopause as “something you have to go through” and to view it as a time to reorient and restructure their lives? A. African Americans B. Japanese Americans C. European Americans D. Urban Latinas Answer: D 5. Which of the following endocrine changes are typical during the last 2 years before the final menstrual period? (Select all that apply.) A. Increased testosterone levels B. Decreased antral follicle count C. Increased follicle-stimulating hormone levels D. Decreased progesterone levels E. Increased estradiol levels Answer: B, C, D 6. Sleep disruption, a common symptom during the menopausal transition, is most often associated with which other perimenopausal symptom? A. Hot flashes B. Decline in memory C. Back pain D. Depressed mood Answer: A 7. Which of the following are common symptoms during the menopausal transition? (Select all that apply.) A. Difficulty concentrating 21 B. Urinary incontinence C. Vaginal dryness D. Increased sexual desire E. Nausea and vomiting Answer: A, B, C 8. Which of the following statements is most accurate concerning symptoms of the menopausal transition? A. Almost all women experience the same set of symptoms, known as menopausal syndrome. B. Almost all women experience hot flashes, but other symptoms are too variable to predict. C. Symptoms experienced appear to vary from culture to culture, and thus may be culture bound. D. Symptoms are completely random, demonstrating no predictable patterns. Answer: C 9. Which of the following accurately describes metabolic changes in bone, muscle, and fat that typically occur in the menopausal transition? A. Increases in bone, muscle, and fat mass B. Decreases in bone, muscle, and fat mass C. Increases in muscle and fat mass but a decrease in bone mass D. Decreases in bone and muscle mass but an increase in fat mass Answer: D 10. Which of the following are characteristics of metabolic syndrome? (Select all that apply.) A. Increased lipid levels B. Insulin resistance C. Decreased inflammatory response D. Increased risk of thrombosis 22 C. 30 minutes of moderate-intensity exercise per day, 5 days per week D. 60 minutes of heavy-intensity exercise per day, 6 days per week Answer: C 14. Isadora is a 49-year-old woman with a body mass index (BMI) of 18 and a family history of osteoporosis. Which of the following health promotion recommendations specifically related to preventing osteoporosis should the nurse give to Isadora? (Select all that apply.) A. Take aspirin daily B. Include plenty of calcium in the diet C. Consume foods fortified with vitamin D D. Limit sodium intake E. Engage in weight-bearing exercise Answer: B, C, E 15. How much more likely are women to be diagnosed with depression in their lifetime than men? A. 60% B. 70% C. 80% D. 90% Answer: B 25 Chapter 6 Assessing Older Women’s Health Debra Hain 1. How many people in the United States were 65 years or older in 2010? A. 3.1 million B. 20.5 million C. 40.3 million D. 83.7 million Answer: C 2. What percentage of those 85 years and older in the United States in 2010 were women? A. 47% B. 57% C. 67% D. 77% Answer: C 3. What percentage of women 85 years and older in the United States in 2010 were widowed? A. 35% B. 52% C. 73% D. 91% Answer: C 4. Compared with older men, older women are: (Select all that apply.) A. More prepared to retire B. Less likely to retire at retirement age C. More likely to have a retirement pension from their employer D. Less likely to report being satisfied in retirement E. More likely to live alone 26 27 Answer: B, D, E 5. In 2030, which of the following is the percentage of the older population (65 years or older) that is projected to be White? A. 47% B. 54% C. 67% D. 74% Answer: A 6. Which of the following cognition-related capacities typically decline with normal aging? (Select all that apply.) A. Motivation B. Short- and long-term memory C. Knowledge D. Learning E. Wisdom Answer: A, B, D 7. Daisy, a 77-year-old client, reports a gradual and slight loss of hearing, especially for higher pitched tones. The nurse should recognize this condition as which of the following? A. Presbyopia B. Presbycusis C. Age-related macular degeneration D. Otitis media C. Presence of a disability D. Social functioning E. Emotional functioning Answer: B, D, E 12. Which of the following are the benefits associated with weight-bearing aerobic exercise in older women? (Select all that apply.) A. Decreased risk for breast cancer B. Increased bone density C. Reversal of Alzheimer’s disease symptoms D. Improved balance E. Improved insulin resistance Answer: B, D, E 13. Opal, who is 82 years old, would like information on vaccinations recommended for clients of her age. Which of the following should the nurse recommend? (Select all that apply.) A. Annual influenza B. Human papillomavirus C. Onetime pneumococcal D. Hepatitis B E. Herpes zoster Answer: A, C, E 14. What percentage of community-dwelling older adults take at least five prescription medications? A. 29% 30 B. 39% 31 C. 49% D. 59% Answer: A II Promotion of Wellness for Women Chapter 7 Women and Sexuality Catherine Ingram Fogel, Diane Marie Schadewald 1. Which of the following are dimensions of sexuality? (Select all that apply.) A. Sexual desire B. Sexual identity C. Ethnic identity D. Presentation of self E. Desire for achievement Answer: A, B, D 2. Sexual health requires which of the following? (Select all that apply.) A. A body mass index (BMI) of 18 to 24.9 B. Awareness and acceptance of one’s body C. Sexual intercourse two to three times per week D. The possibility of pleasurable, safe sexual experiences E. The absence of any sexually transmitted infection Answer: B, D, E 3. Which of the following are characteristics of women’s sexual response? (Select all that apply.) A. Highly consistent among a woman’s life stages B. Highly variable among different women C. Expectations and perceptions influenced by culture D. A complex interplay of psychological, physiological, and interpersonal components E. Unaffected by religious beliefs 32 35 nurse sees on Wendy’s questionnaire that her period is a week later than usual. What would be the most effective way for the nurse to begin the conversation with Wendy? A. “Many young women your age experience irregular periods for different reasons. Is this something you are experiencing?” B. “So, I see that your period is late. Do you think you are pregnant?” C. “Have you been using condoms when you have sex with your boyfriend?” D. “Don’t worry. It’s highly unlikely that you are pregnant, only being a week late.” Answer: A 11. In the PLISSIT (permission, limited information, specific suggestions, and intensive therapy) model of sexual health care interventions, the first step is which of the following? A. Perform a Pap smear B. Palpate the client’s abdomen C. Ask about the patient’s past medical history D. Ask permission to discuss sexual function Answer: D 12. When conducting a sexual assessment with a client, Ellie, the client gets angry and says that her partner is always so selfish and is only concerned with her own sexual needs. She relates a string of recent experiences with her partner and then says, “What do you think I should do?” Which of the following would be the most appropriate response for the nurse to give? A. “I agree that your partner is being selfish. You might consider breaking up with her.” B. “Why don’t we schedule a follow-up appointment with you and your partner so that we can discuss this 36 together.” C. “When my husband is being selfish, I just refuse to have sex with him. Maybe you should do the same.” D. “Let me refer you to a good sex therapist I know. She is better trained to provide the kind of care you require.” Answer: D 13. A patient reports chronic pain in the vulvar area that has persisted for 4 months. The nurse recognizes this condition as which of the following? A. Vulvodynia B. Vestibulodynia C. Dyspareunia D. Genitopelvic pain/penetration disorder Answer: A 14. A patient reports experiencing fear and anxiety just before having intercourse related to the pain she anticipates experiencing. She also reports feeling uncomfortable tension in her pelvic floor muscles during intercourse. The nurse recognizes this condition as which of the following? A. Vulvodynia B. Vestibulodynia C. Dyspareunia D. Genitopelvic pain/penetration disorder Answer: D 15. A nurse is counseling a 15-year-old client whose boyfriend wants her to try drinking acouple of beers before they have sex. Which of the following effects of alcohol use on sexual function should the nurse mention to the client? A. An intensified orgasm for both her and her boyfriend B. Increased fear and anxiety about having sex C. Increased risk taking in sex, such as not using a condom D. Increased vaginal lubrication Answer: C Chapter 8 H Health Needs of Lesbian, Bisexual, and Transgender Populations 1. The primary cause of health disparities among lesbian, gay, bisexual, and transgender (LGBT) individuals is believed to be which of the following? A. Lack of awareness of need for care B. Increased genetic risk C. Hormonal changes D. Societal stigma and marginalization Answer: D 2. LGBT persons are believed to comprise what percentage of the population? A. 1% to 2.5% B. 3.8% to 10% C. 10.3% to 15.8% D. 16.1% to 21.7% Answer: B 3. A nurse practitioner recently joined a practice with a diverse clientele, including persons of all sexual orientations and gender identities. How should the nurse approach these clients? (Select all that apply.) A. Avoid bringing up sexual orientation or gender identity 37 40 7. Melissa is a 62-year-old lesbian client. On the basis of her age and sexual orientation, Melissa is more likely to do which of the following? (Select all that apply.) A. Live alone B. Have HIV C. Lack family support for meeting basic needs D. Fear discrimination when accessing medical services E. Be homeless Answer: A, C, D 8. What condition related to gender identity is included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)? A. Gender dysphoria B. Gender identity disorder C. Transgender disorder D. Body dysmorphic disorder Answer: A 9. Jackie is a 19-year-old transwoman who has arrived at the office today for a physical. What health disparities should the nurse assess for in Jackie? (Select all that apply.) A. Risky sexual behaviors B. Depression C. Multiple sclerosis D. Trauma and violence E. Substance abuse Answer: A, B, D, E 41 42 10. Meg is a 15-year-old bisexual client. Which of the following is Meg at a greater risk for than her heterosexual counterparts? (Select all that apply.) A. Spinal cord injury B. Experiencing school bullying C. Bipolar disorder D. Homelessness E. Suicidality Answer: B, D, E Chapter 9 Health Needs of Women with Disabilities Michele Davidson 1. The inability to carry out relevant roles due to the social impact of either a physical impairment or a functional limitation is known as which of the following? A. Disorder B. Disease C. Disability D. Distress Answer: C 2. Which of the following is a condition that is “age related” rather than “ageing related”? A. Cardiomyopathy B. Osteoarthritis C. Presbyopia D. Presbycusis Answer: A 3. Which of the following is a condition that is “ageing related” rather than “age related”? A. Presbyopia A. Dementia B. Dyslexia C. Attention deficit hyperactivity disorder D. Obsessive-compulsive disorder Answer: A Chapter 10 Integrating Wellness: Complementary Therapies and Women’s Health J o Lynne W. Robins MULTIPLE CHOICE 1. A pregnant woman tells the nurse that she got relief from nausea when she had a therapy that involves pressure and massage on meridian sites. What type of therapy does this describe? a. Acupuncture b. Acupressure c. Aromatherapy d. Ayurveda ANS: B Acupressure uses finger pressure and massage on the meridian sites. It can be used during pregnancy to control nausea, backache, and pain. It has been useful for minor postpartum problems such as constipation. 2. Which child should not receive massage therapy? a. 15-year-old with a fractured femur b. 12-year-old with diabetes mellitus c. 8-year-old with Down syndrome d. 17-year-old with an eating disorder ANS: C Children with Down syndrome are prone particularly to cervical spine anomalies and may be injured by massage therapy. 3. A 12-year-old with rheumatoid arthritis finds aromatherapy helpful for relieving her joint discomfort. Which essential oil is useful for children with chronic pain? a. Lavender b. Ephedra c. Ginseng d. Kava-kava ANS: A Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children with chronic pain. 4. A pregnant woman wishes to use aromatherapy during her labor and delivery. What is the most appropriate essential oil for the nurse to recommend? a. Juniper b. Wintergreen c. Thyme d. Citrus 45 46 ANS: D Citrus is one essential oil that has been shown to be useful during labor and delivery. 5. A parent asks the nurse, What is guided imagery? Which statement is the most accurate response? a. It is a technique where the patient focuses on an image to relieve stress. b. It involves using water to promote relaxation. c. The patient enters a hypnotic state of sleep to promote relaxation. d. It helps the patient recognize tension in the muscles with responses on an electronic machine. ANS: A In guided imagery, by focusing on a specific image, stress reduction and improved performance can result. 6. A woman taking St. Johns wort and ginseng daily is scheduled to have a hysterectomy in 3 weeks. What instruction should the nurse provide? a. The herbs are not likely to cause any problems during the surgery. b. The St. Johns wort must be stopped prior to surgery, but she can continue the ginseng. c. The ginseng should be stopped 1 week before surgery. d. She should discontinue taking both herbs 2 weeks before surgery. ANS: D Both St. Johns wort and ginseng can cause problems during surgery, and their use should be discontinued 2 weeks before surgery. 7. Which herb can the nurse suggest to be used for discomforts associated with menopause, such as hot flashes? a. Evening primrose oil b. Echinacea c. Milk thistle d. Black cohosh ANS: D Black cohosh diminishes hot flashes by reducing luteinizing hormone. It also reduces joint pain and other menopausal discomforts. 8. A young mother asks, Is there an alternative medicine for children with asthma? Which form of alternative medicine would be the most helpful for the nurse to suggest? a. Reflexology b. Rolfing c. Guided imagery d. Acupressure ANS: C The use of guided imagery has helped relieve some of the symptoms of asthma. 9. What is the difference between complementary therapy and alternative therapy? a. Complementary therapy must be administered by a medical doctor. b. Complementary therapy is administered with conventional therapy. c. Complementary therapy replaces conventional therapy. d. Complementary therapy is administered to a group of patients at the same time. ANS: B Complementary therapy is administered with conventional therapy, such as massage with muscle relaxants for low back pain. 10. The nurse uses a diagram to show the location of meridians. How will the nurse explain the definition of meridians? a. They are lymph nodes. b. They are invisible pathways for energy. c. They are lines that divide the body into 10 zones. d. They are areas of skin that are specifically innervated. ANS: B Meridians are invisible pathways through which energy travels to effect acupuncture treatment. 11. Which herbal remedy used by a patient taking warfarin should the nurse report to the physician? a. Angelica (dong quai) b. Chamomile c. Ginseng d. Kava-kava ANS: A Angelica prolongs prothrombin time and will synergize the effect of the warfarin. 12. What should the nurse remind a parent who is considering homeopathic remedies for treatment of her childs asthma? a. Should be drunk with large amounts of fluid b. Can be taken with traditional Western medications c. Can be enhanced by drinking hot tea d. May contain mercury, alcohol, or arsenic ANS: D Homeopathic remedies often contain mercury, alcohol, or arsenic and are taken sublingually. All Western medications should be stopped when the homeopathic therapy is begun. Caffeine drinks are to be avoided during homeopathic treatment. 13. The focus of acupressure is to restore the balance of what? a. Chi b. Shiatsu c. Yin and yang d. Ayurveda ANS: A Acupressure is focused on the return of the balance of Chi to control disease processes. 14. A breastfeeding mother tells the nurse she is taking large doses of vitamin C to keep up her energy. What should the nurse warn that large doses of vitamin C can cause in an infant? a. Diarrhea b. Jaundice c. Colic d. Retinal damage ANS: C Vitamin C can be passed on to a breastfeeding child through breast milk and can cause colic. 15. The pregnant patient with a stasis ulcer asks if she might be a candidate for hyperbaric oxygen therapy (HBOT). What is the nurses best response? a. Yes. Hyperbaric oxygen therapy should have no harmful effect on your baby. b. No. High amounts of oxygen in your system will cause changes in your babys heart. c. Yes. Hyperbaric oxygen therapy is a much better option than using antibiotics. d. No. Hyperbaric oxygen therapy may cause the placenta to separate fromthe uterine wall. ANS: B 47 50 Light therapy has proven effective in the treatment of persons with seasonal affective disorders. Light therapy is also used in the treatment of jaundiced babies. 20. What advantage(s) of alternative health care should the nurse outline when providing information to patients? (Select all that apply.) a. Offering more patient control of health care b. Offering a variety of health care advisors c. Keeping patients from having to make decisions d. Using natural products rather than chemical ones e. Incorporating cultural beliefs and practices ANS: A, B, D, E Alternative health care actually promotes the patients decision making in care. 21. Which approaches to care are combined with osteopathy? (Select all that apply.) a. Manipulation therapy b. Aroma therapy c. Herbal application d. Pressure point therapy e. Traditional medicine ANS: A, D, E DIF: III Promotion of Gynecologic Health Care Chapter 11 Menstruation and Related Problems and Concerns Kristine Alswager, Christine Durler, Deborah Griswold 1: The symptoms of premenstrual syndrome typically resolve a: by the end of menses b: about 2 weeks after the start of menses c: 2 weeks before the onset of menses d: at the time of ovulation 2: In premenstrual syndrome, there is a symptom-free interval of at least a: 1 week per cycle b: 1cycle out of 4 c: 2weeks per cycle d: 2 cycles per year 3: The maximum estimated incidence of women with some physical or emotional premenstrual symptoms is 51 a: 60%-70% b: 45%-55% c: 30%-40% d: 75%-85% 4: Premenstrual dysphoric disorder occurs in what percent of women? a: 5% b: 75% c: 50% d: 25% 5: In making the diagnosis of premenstrual syndrome or PMDD, the characteristic that is most distinguishing is the a: duration of symptoms b: 52 a: treating her for hypothyroidism b: asking her to keep a menstrual diary for 2 months c: ordering a pelvic ultrasound d: giving her a prescription of fluoxetine to be taken only during the luteal phase 11: A patient keeps a menstrual diary for 2 months. The diary reveals that she has bloating, fatigue, anxiety, insomnia, and tearfulness in the days prior to her menses and that the symptoms resolve completely after her menses starts. She reports that her insomnia is so bad that it prevents her from being efficient at work because she is not well rested. The most likely diagnosis for this patient is a: bipolar disorder b: PMDD c: major depressive disorder d: PMS 12: A patient with PMDD asks for some treatment options. You respond that the treatment that has clearly demonstrated benefit for her condition is a: 55 GnRH agonist b: sertralin e c: danazo l d: ovarian suppression with high-dose depot medroxyprogesterone 13: Which of the following has been shown to significantly improve the symptoms of women with PMS? a: Light therapy b: Vitamin E c: Evening primrose d: Aerobic exercise 14: Which of the following would be the first line of treatment in the management of symptoms of PMS? a: Selective serotonin reuptake inhibitors b: GnRH agonist c: Complex carbohydrate diet 56 d: Oral contraceptive 15: An important diagnosis to distinguish from PMDD is major depressive disorder. Which of the following is increased in patients with major depressive disorder but not in patients with PMDD? a: Sleep disturbance b: Suicide risk c: Anxiet y d: Disordered eating [ANS: a,a,d,a,b,a,c,b,d,b,b,b,d,c,b] 57 8 e: 24 5: E. In the first year of use, the typical use pregnancy rate for a woman using a copper intrauterine contraceptive is a: 8 b: 1.5 c: 0.8 d: 10 e: 3 6: F. Which of the following is the least effective birth control option? a: Combination oral contraceptives b: Cervical cap c: Monthly transvaginal ring d: 60 Weekly transdermal patch e: Three-month injectable 7: G. The failure of oral contraceptives usually is related to a: interference by other medications that the patient is taking b: an inherent problem in the estrogen-to-progesterone ratio c: altered gastrointestinal absorption of the oral contraceptive caused by hormonal influences d: ingestion of the oral contraceptive agent with alcohol e: missed doses of the oral contraceptive 8: H. Which of the following contraceptive techniques relies the least on patient compliance? a: Contraceptive ring b: Combination pill c: Progestin pill d: Contraceptive patch 61 e: Contraceptive implant A 24-year-old Latin American female G2P2 sees you for her annual. She is about to wean her baby in a few months and is on the progesterone-only pill. She really likes this particular pill because she has had no periods while breastfeeding. She wonders if she can continue to use it. 9: A. You counsel her that one of the main reasons to consider switching to combination birth control pills is a: better lipid profile b: better control of her moods c: better cycle control d: better weight loss e: better control of her acne 10: B. Which of the following statements about the progestin-only minipill is correct? a: It cannot be started postpartum until at least 2 months after delivery b: It is taken once per week c: 62 her painful periods that may be consistent with endometriosis c: her smoking one pack per day d: her history of breast cancer in her mother e: her family history of hypertension 15: B. What is the primary mechanism of action of oralcontraceptives? a: Inhibit ovulation b: Impose a barrier between the sperm and the egg c: Create an environment in the uterus that is toxic to the sperm d: Destroy the embryo shortly after fertilization e: Alter the ability of the fertilized egg to implant and grow 16: C. Which is a contraindication to the birth control pill? a: Smoking in a woman older than 35 years b: A family history of stomach cancer 65 c: Dysmenorrhe a d: A history of ovarian cysts 17: D. Other than investigating the cause, what action should be taken when a woman using anoral contraceptive experiences a headache? a: Increase oral contraceptive to twice daily b: Switch to the phasic pill c: Continue oral contraceptive d: Discontinue all contraception e: Discontinue oral contraceptive A 16-year-old sees you in the Derm Clinic. She is hesitant because she heard antibiotics made "your birth control not work." You reassure her that most common antibiotics do not lessen the effectiveness of birth control pills. 18: A. When taken concurrently, which of the following will reduce the effecacy of oral contraceptives? a: Tetracyclin e b: 66 Aspiri n c: Phenytoi n d: Metronidazol e e: Methyldopa 19: B. Which of the following best describes "phasic" formulation of oralcontraceptives? a: They contain only progestin in varying doses b: They contain varying doses of hormones throughout the cycle pack c: They are mostly used postpartum d: They contain a higher dose of hormones per month than monophasic contraceptive pills e: They have a different mechanism of action than monophasic pills 20: In which of the following casses should biphasic oral contraceptives be discontintued? A: Galactorrhea b:Right upper quadrant pain c:Amenorrhea d:Anemia e:Hepatic mass with tenderness ANS: [b,b,e,c,c,b,e,e,c,d,c,a,b,a,a,a,c,c,b,e] 67 70 Answer: D 7. Which of the following are risk factors for males related to infertility? (Select all that apply.) A. Undescended testicles B. History of radiography of the groin C. Onset of puberty at the age of 13 years D. Erectile dysfunction E. Mumps-related orchitis Answer: A, B, D, E 8. Hope, a 35-year-old client, has been diagnosed with oligomenorrhea. Which of the following are medications the nurse should consider prescribing to Hope to induce ovulation and aid conception? (Select all that apply.) A. Mifepristone B. Levonorgestrel C. Clomiphene citrate D. Aromatase inhibitor E. Human chorionic gonadotropin Answer: C, D, E 9. Which assistive reproductive technology has a higher fecundability than natural conception? A. Intrauterine insemination B. Gamete intrafallopian transfer C. In vitro fertilization D. Zygote intrafallopian transfer Answer: C 10. What recommendations related to use of reproductive technologies should the nurse follow to help avoid ethical problems? (Select all that apply.) A. Progress from invasive to conservative measures B. Avoid excessive treatments and costs C. Provide full disclosure regarding success rates of a procedure before initiating it D. Offer counseling for gamete donors, surrogates, and their partners E. Insist that the offspring conceived by gamete donation be informed ofthe nature of conception by the age of 12 years Answer: B, C, D 11. A client with ovarian cancer who will be undergoing surgery and radiation therapy is concerned that she will become infertile as a result of the treatment. Which of the following should the nurse recommend that the client consider? A. Cryopreservation of her oocytes B. Estrogen therapy C. Intrauterine insemination D. Adoption Answer: A 71 72 Chapter 14 Vaginitis and Sexually Transmitted Diseases Susan D. Schaffer, Jane Houston A 16-year-old virginal is brought in by her mother because of possible vaginal infections. Which of the following descriptions is most consistent with normal (physiologic) discharge? a: White, clear, and flocculent b: White, curds, cottage cheese- like c: Gray-green, thin, and adherent d: Gray-green, frothy 2: A 24-year-old patient requests treatment for what she believes is a bacterial infection of the vagina. Which of the following is characteristic of vaginal discharge in cases of bacterial vaginosis? a: Fishy odor b: pH<4.5 c: Whitish color d: Curdy consistency 3: A 40-year-old patient has recently been treated for a urinary tract infection with antibiotics. She now complains of a possible yeast infection. Discharge in cases of vaginal candidiasis is characterized by d: the Bartholin glands 8: A 19-year-old patient who was concerned about vaginal discharge was found to have normal vaginal secretions. Which of the following is the most appropriate management? a: Return as needed. b: Return after a single pill of fluconazole. c: Return after a 3-day course of metronidazole. d: Return after the next period. 9: The normal pH of vaginal secretions in a reproductive-age woman is a: 3.5-4.5 b: 6.5-7.5 c: 5.0-6.0 d: 8.0-9.0 10: 75 76 What is the difference in the normal pH of the vagina before and after menopause? a: Same in pre- and postmenopausal patient b: Varies depending on the phase of the premenopausal cycle c: Higher in premenopausal patient d: Higher in postmenopausal patient 11: A 38-year-old patient requests treatment for a yeast infection but declines an examination because she is on her period. The most common symptom associated with vulvovaginal candidiasis is a: pai n b: feve r c: fishy smelling discharge d: pruritus 12: A 38-year-old patient requests evaluation of a fishy-smelling discharge. Which of the following is a criterion for the diagnosis of bacterial vaginosis? a: Presence of clue cells b: Negative "whiff" test c: Cottage cheese-like discharge d: pH less than 4.5 13: A 45-year-old woman complains of a copious vaginal discharge. Which of the following is a common cause of increased vaginal discharge? a: Trichomonias is b: Herpe s c: Human papillomavirus d: Atrophic vaginitis 14: A 25-year-old patient complains of vaginal discharge that is white and curdy in appearance. What is the appropriate method to establish the diagnosis? a: Constellation of symptoms b: Odor of the discharge 77 a: Trichomonas vaginitis b: Atrophic vaginitis c: Bacterial vaginosis d: Vulvovaginal candidiasis 20: A 29-year-old patient is undergoing evaluation for a symptomatic discharge. Which of the following characterizes the microscopic appearance of Trichomonas? a: Ground-glass cytoplasm b: Pseudohypha e c: Flagellate protozoan d: Bacillus 21: What characteristic lesions may be found in the upper vagina or on the cervix of patients with Trichomonas vaginalis? a: Ulcer s 80 b: White plaques c: Clear blisters d: Petechiae 22: A 26-year-old patient is told by her boyfriend that he has Trichomonas. She has developed a copious discharge recently. The standard treatment for Trichomonas vaginal infection is a: oral clindamycin b: oral fluconazole c: oral metronidazole d: topical synthetic imidazoles 23: A 30-year-old patient is receiving a prescription for metronidazole for the treatment of Trichomonas. What additional advice should she receive? a: Avoid nonsteroidal anti-inflammatory agents b: Avoid alcohol c: 81 Avoid caffeine d: Take vitamin supplementation 24: A 22-year-old patient inquires as the origin of the yeast infection for which she is being treated. She can be informed that the most common source of monilial infections of the vagina is a: sexual contact with an infected partner b: bath water retained in the vagina following bathing c: contaminated clothing d: airborne colonization 25: Roughly 90% of vaginal "yeast" infections are caused by a: Candida tropicalis b: Torulopsis glabrata c: Candida glabrata d: Candida albicans ANS: [aaadc baaad daadb abbac dcbdd] 82 85 E) Sexual intercourse. After teaching a class on sexually transmitted infections, the instructor determines that the 17.teaching was successful when the class identifies which statement as true? A) STIs can affect anyone if exposed to the infectious organism. B) STIs have been addressed more on a global scale. C) Clients readily view the diagnosis of STI openly. D) Most individuals with STIs are over the age of 30. A group of students are reviewing information about STIs. The students demonstrate 18.understanding of the information when they identify which of the following as the most common bacterial STI in the United States? A) Gonorrhea B) Chlamydia C) Syphilis D) Candidiasis A nurse is assessing a client for possible risk factors for chlamydia and gonorrhea. Which of the 19.following would the nurse identify? A) Asian American ethnicity B) Age under 25 years C) Married D) Consistent use of barrier contraception A nurse at a local community clinic is developing a program to address STI prevention. Which of the following would the nurse least likely include in the program? A) Outlining safer sexual behavior B) Recommending screening for symptomatic individuals C) Promoting the use of barrier contraceptives D) Offering education about STI transmission After teaching a class on preventing pelvic inflammatory disease, the instructor determines that 21.the teaching was successful when the class identifies which of the following as an effective method? A) Advising sexually active females to use hormonal contraception B) Encouraging vaginal douching on a weekly basis. C) Emphasizing the need for infected sexual partners to receive treatment D) Promoting routine treatment for asymptomatic females as risk A group of nursing students are reviewing information about vaccines used to prevent STIs. 22.The students would expect to find information about which of the following? A) HIV B) HSV C) HPV D) HAV E) HBV A mother brings her 12-year-old daughter in for well-visit checkup. During the visit, the nurse 23. is discussing the use of prophylactic HPV vaccine for the daughter. The mother agrees and the daughter receives her first dose. The nurse schedules the daughter for the next dose, which would be given at which time? A) In 2 month B) In 2 months C) In 3 months D) In 4 months A woman comes to the clinic complaining of a vaginal discharge. The nurse suspects trichomoniasis based on which of the following? (Select all that apply.) A) Urinary frequency 20. 24. B) Yellow/green discharge C) Joint pain D) Blister-like lesions E) Muscle aches A nurse is teaching a women with genital ulcers how to care for them. Which statement by the 25.client indicates a need for additional teaching? A) I need to wash my hands after touching any of the ulcers. B) I need to abstain from intercourse primarily when the lesions are present. C) I should avoid applying ice or heat to my genital area. D) I can try lukewarm sitz baths to help ease the discomfort. Answer Key 1. C 2. A 3. B 4. A 5. D 6. B 7. C 8. A 9. D 10.B 11.B 12.C 13.B, C, D, E 14.D 15.C 16.A, C, D, E 17.A 18.B 19.B 20.B 21.C 22.C, D, E 23.B 24.A, B 25.B 86 Chapter 16 Common Gynecologic Pelvic Disorders Jennifer M. Laubach, Reena P. Lorntson, Donna E. Forrest 1: Enterocele is defined as herniation of what organ through the vagina? a: Uteru s b: Bladde r c: Small bowel d: Urethra 2: A 45-year-old patient complains of frequent loss of urine when she coughs, laughs, or strains. The volume lost is small. She does not report any dysuria. Which type of incontinence does she have? a: Urg e b: Overflo w c: Stres s d: Psychogenic 3: A 45-year-old patient complains of frequent loss of urine. The volume lost is small, but it occurs almost continuously. She denies urgency, has no dysuria, and voids frequently but in small amounts. She does 87 c: rectocel e d: cystocele 8: A "Q-tip test" is used to evaluate a: residual urine b: urethral mobility c: posterior vaginal wall support d: uterine prolapse 9: When performing a "Q-tip test," incontinence is generally associated with upward rotation of a: 45 degrees b: 10 degrees c: 20 degrees d: 30 degrees 90 10: What term is applied when the cervix descends below the vulva? a: Rectocel e b: Enterocel e c: Procidenti a d: Cystocele 11: Pelvic muscle training programs are most useful for what type of incontinence? a: Psychogeni c b: Overflo w c: Urg e d: Stress 12: What is the purpose of Kegel exercises? a: Improve bladder capacity and control 91 b: Increase bladder awareness c: Strengthen pelvic floor muscles d: Tighten uterine ligaments 13: A 45-year-old patient is undergoing nonsurgical management of genitourinary problems related to her recent pregnancy. Kegel exercises may be useful in a patient with a: dyspareuni a b: mild stress incontinence c: symptomatic rectocele d: second-degree prolapse of the uterus 14: What is the primary purpose of a ring pessary? a: Decrease bladder capacity b: Obstruct the urethra c: Channel intra-abdominal pressure toward the introitus 92 1,000 colonies of Bacteroides species c: 10,000 colonies of Staphylococcus aureus d: 10,000 colonies of Escherichia coli 20: Cystocele is best defined as a: descent or prolapse of the rectum b: descent or prolapse of the urethra c: descent or prolapse of the bladder d: herniation of the top of the vagina 21: Which of the following is the best description of a rectocele? a: herniation of the top of the vagina b: descent or prolapse of the rectum c: descent or prolapse of the urethra d: descent or prolapse of the bladder 95 22: Procidentia describes uterine descent beyond the a: vulv a b: ischial spines c: level of the uterine artery d: plane of the pelvic inlet 23: What is the stage of prolapse when the leading part of the prolapse is more than 1 cm beyond the hymen but less than or equal to the total vaginal length? a: I b: III c: II d: IV 24: What is the condition in which the bladder forces the anterior vaginal wall down and out? 96 a: Cystocel e b: Enterocel e c: Rectocel e d: Procidentia 25: Which of the following is the best way to identify a urethral diverticulum? a: Multichannel urodynamic testing b: The Q-tip test c: Cystourethroscop y d: Single-channel urodynamic testing ANS:[ ccbca dabdc dcbdb bcdcd babac ] 97