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Chapter 06
Question 1
Type: MCSA
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.”
3. “Breast swelling and pressure are expected symptoms, but pain is abnormal and should be evaluated by your
physician.”
Correct 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.
Global Rationale:
Question 2
Type: MCSA
The nurse is caring for a patient diagnosed with endometriosis. Which statement by the patient requires immediate
follow-up?
3. “My leg has become painful and swollen since I started taking birth control pills.”
Correct 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 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.
Global Rationale:
Question 3
Type: MCSA
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?
Correct 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 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.
Global Rationale:
Question 4
Type: MCSA
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?
Correct 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 3: An increased risk for cancer of the ovary and breast is associated with endometriosis.
Global Rationale:
Question 5
Type: MCSA
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."
Correct 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.
Global Rationale:
Question 6
Type: MCMA
The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement
should be included in this session?
2. “The doctor will be able to tell why you have not conceived.”
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 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.
Global Rationale:
Question 7
Type: MCSA
Which patient in the gynecology clinic should the nurse see first?
Correct Answer: 1
Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank
Copyright 2014 by Pearson Education, Inc.
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.
Global Rationale:
Question 8
Type: MCSA
Correct 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.
Global Rationale:
Question 9
Type: MCSA
Correct 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
Global Rationale:
Question 10
Type: MCSA
The physician has prescribed metronidazole (Flagyl) for a woman diagnosed with trichomoniasis. The nurse’s
instructions to the woman should include:
Correct Answer: 1
Global Rationale:
Question 11
Type: MCMA
The couple demonstrates understanding of the consequences of not treating Chlamydia when they state:
3. “He could get an infection in the tube that carries the urine out.”
Rationale 5: Chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the uterus,
fallopian tubes, and sometimes ovaries.
Global Rationale:
Question 12
Type: MCSA
Which of the following patients should be treated with ceftriaxone (Rocephin) IM and doxycycline (Vibramycin)
orally?
Correct Answer: 2
Rationale 2: This combined treatment provides dual treatment for gonorrhea and Chlamydia because the two
infections frequently occur together.
Global Rationale:
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.
Correct 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.
Global Rationale:
Question 14
Type: MCMA
The nurse is discharging a patient after hospitalization for pelvic inflammatory disease (PID). Which statements
indicate that teaching was effective?
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.
Global Rationale:
Question 15
Type: MCSA
Which of the following diagnostic tests would the nurse question when ordered for a patient diagnosed with
pelvic inflammatory disease (PID)?
Correct Answer: 3
Rationale 1: CBC with differential will give an indication of the severity of the infection.
Global Rationale:
Question 16
Type: MCSA
The nurse is to tell a patient that her Pap smear result was abnormal. Which statement should the nurse include?
Correct 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.
Global Rationale:
Question 17
Type: MCSA
The nurse is preparing an education session for women on prevention of urinary tract infections (UTIs). Which
statement should be included?
Correct 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.
Global Rationale:
Question 18
Type: MCSA
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:
Correct 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.
Global Rationale: