Question 1

A school nurse is presenting information on human development and sexuality. When describing the role of hormones in sexual development, which hormone does the nurse teach the class is the most important one for developing and maintaining the female reproductive organs?

Accepted Answer

Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.

Question 2

The nurse is taking the sexual history of an adolescent who has come into the free clinic. What question best assesses the patients need for further information?

Accepted Answer

An open-ended question related to the patients need for further information should be included while obtaining a sexual history. None of the other listed questions are open-ended.

Question 3

The nurse is being trained to perform assessment screenings for abuse on patients who come into the walk-in clinic where the nurse works. Which of the following assessment questions is most appropriate?

Accepted Answer

Asking about abuse directly is effective in identifying the presence of abuse and should be included in the health history of all women. Oblique questions that relate to the character of the relationship or conflict resolution are less useful clinically. Asking about making a partner angry is not an appropriate way to screen for family violence because it does not directly address the problem.

Question 4

A premenopausal patient is complaining of vaginal spotting and sharp, colicky lower abdominal pain. She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this patient to be investigated for what health problem?

Accepted Answer

Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal infection. Cervical cancer and fibromyalgia do not affect menstruation.

Question 5

A female patient who has cognitive and physical disabilities has come into the clinic for a routine checkup. When planning this patients assessment, what action should the nurse take?

Accepted Answer

When working with women who have disabilities, it is important that the nurse avoid equating the woman with her disability; the nurse must make an effort to understand that the patient and the disability are not synonymous. A chaperone is not necessarily required and there may or may not be a need to abbreviate the assessment. The nurse should provide education as needed.

Question 6

A patient calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data?

Accepted Answer

Drainage caused by Candida is typically curd-like and white. Trichomonas infections usually cause copious, frothy yellowish-green discharge. There is no immediate need for a Pap smear, as malignancy is an unlikely cause.

Question 7

A nurse presenting an educational event for a local community group is addressing premenstrual syndrome (PMS). What treatment guideline should the nurse teach this group?

Accepted Answer

In general, the patient is encouraged to increase or initiate an exercise program to help relieve symptoms of PMS. Fluid intake should be increased. Opioids are not used to treat PMS. Stress reduction has multiple benefits, but it is not noted to alleviate the symptoms of PMS.

Question 8

A nurse is collecting assessment data from a premenopausal patient who states that she does not have menses. What term should the nurse use to document the absence of menstrual flow?

Accepted Answer

Amenorrhea refers to absence of menstrual flow, whereas dysmenorrhea is painful menstruation. Menorrhagia, also called hypermenorrhea, is defined as prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to vaginal bleeding between regular menstrual periods.

Question 9

A patient who is in the first trimester of pregnancy has experienced an incomplete abortion. The obstetric nurse should prepare the patient for what possible intervention?

Accepted Answer

If only some of the tissue is passed, the abortion is referred to as incomplete. An emptying or evacuation procedure $(\mathrm{D} \& \mathrm{C}$, or dilation and evacuation $[\mathrm{D} \& \mathrm{E}])$ or administration
of oral misoprostol (Cytotec) is usually required to remove the remaining tissue. Bed rest will not necessarily result in the passing of all the tissue. Clomiphene and hydromorphone are of no therapeutic benefit.

Question 10

A patient in her late fifties has expressed to the nurse her desire to explore hormone replacement therapy (HRT). Based on what aspect of the patients health history is HRT contraindicated?

Accepted Answer

The use of HRT is contraindicated in women with a history of vascular thrombosis, active liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HRT is beneficial in women with a risk for osteoporosis. Vaginal dryness, hot flashes, and night sweats are symptoms of menopause that may be relieved with HRT.

Question 11

The school nurse is presenting a class on female reproductive health. The nurse should describe what aspect of Pap smears?

Accepted Answer

The test should be performed when the patient is not menstruating. Douching washes away cellular material. The test detects cervical cancer, and falsenegative Pap smear results occur mostly from sampling errors or improper technique. For most women, a Pap smear should be done annually.

Question 12

A nurse practitioner is preparing to perform a patients scheduled Pap smear and the patient asks the nurse to ensure that the speculum is well-lubricated. How should the nurse proceed with assessment?

Accepted Answer

Because lubricants may obscure cells on a Pap smear, warm water is the only lubricant that can be used.

Question 13

A clinic nurse is meeting with a 38-year-old patient who states that she would like to resume using oral contraceptives, which she used for several years during her twenties. What assessment question is most likely to reveal a potential contraindication to oral contraceptive use?

Accepted Answer

Women who smoke and who are 35 years of age or older should not take oral contraceptives because of an increased risk for cardiac problems. Previous surgeries, STIs, and blood sugar instability do not necessarily contraindicate the use of oral contraceptives.

Question 14

A 17-year-old girl has come to the free clinic for her annual examination. She tells the nurse she uses tampons and asks how long she may safely leave her tampon in place. What is the nurses best response?

Accepted Answer

Tampons should not be used for more than 4 to 6 hours, nor should super-absorbent tampons be used because of the association with toxic shock syndrome. If used appropriately, it is acceptable and safe for the patient to use tampons.

Question 15

A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the patient?

Accepted Answer

For some women, vitamins $\mathrm{B}_{6}$ and $\mathrm{E}$ have proven beneficial for the treatment of hot flashes. Sodium
restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.

Question 16

A newly pregnant patient is being assessed in an obstetric clinic. The patient states that she has been experiencing intense abdominal pain and the nurse anticipates that the patient will be assessed for ectopic pregnancy. In addition to ultrasonography, what diagnostic test should the nurse anticipate?

Accepted Answer

If an ectopic pregnancy is suspected, the patient is assessed using ultrasound and hCG testing. CT and xrays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.

Question 17

An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what?

Accepted Answer

Dysfunctional uterine bleeding can occur at any age, but is most common at opposite ends of the reproductive life span. It is usually secondary to anovulation (lack of ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or ectopic pregnancy.

Question 18

The nurse is planning the sexual assessment of a new adolescent patient. The nurse should include what assessment components? Select all that apply.

Accepted Answer

A sexual assessment includes both subjective and objective data. Health and sexual histories, physical examination findings, and laboratory results are all part of the database. A sexual assessment would not normally include the patients interpersonal skills. It is not likely to necessary to assess an adolescents understanding of menopause.

Question 19

By initiating an assessment about sexual concerns what does the nurse convey to the patient? Select all that apply.

Accepted Answer

By initiating an assessment about sexual concerns, the nurse communicates to the patient that issues about changes or problems in sexual functioning are valid and significant health issues. The nurse communicates that it is safe to talk about sexual issues and that changes or challenges in sexual function are not unusual.

Question 20

The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new patient. According to this model, the nurse should begin with what action?

Accepted Answer

The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.

Quiz 55: Assessment and Management of Patients With Female Physiologic Processes