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Maternity & Women’s Health Care 10th

Edition by Kathryn Rhodes – Deitra


Leonard Lowdermilk
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Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – Deitra Leonard Lowdermilk

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

Chapter 06: Reproductive System Concerns

Test Bank

MULTIPLE CHOICE

1. When assessing the client for amenorrhea, the nurse should be aware that this may be caused
by all conditions except:

a. Anatomic abnormalities
b. Type 1 diabetes mellitus

c. Lack of exercise

d. Hysterectomy

ANS: C

Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea.

Anatomic abnormalities are a possible cause of amenorrhea.

Type 1 diabetes mellitus is a possible cause of amenorrhea.

Hysterectomy is a possible cause of amenorrhea.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic


intervention might be recommended?

a. Increasing the intake of red meat and simple carbohydrates

b. Reducing the intake of diuretic foods, such as peaches and asparagus

c. Temporarily substituting physical activity for a sedentary lifestyle

d. Using a heating pad on the abdomen to relieve cramping

ANS: D

Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing
uterine ischemia.
Dietary changes such as eating less red meat may be recommended for women experiencing
dysmenorrhea.

Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice,
peaches, parsley, and watermelon may help ease the symptoms associated with dysmenorrhea.

Exercise has been found to help relieve menstrual discomfort through increased vasodilation and
subsequent decreased ischemia.

DIF: Cognitive Level: Analysis REF: 121

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. Nafarelin (Synarel) is used to treat mild to severe endometriosis. The nurse should tell the
woman taking this medication that the drug:

Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating


a. ovarian activity

b. Should be sprayed into one nostril every other day

c. Should be injected into subcutaneous tissue bid

d. Can cause her to experience some hot flashes and vaginal dryness

ANS: D

Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The
hypoestrogenism effect results in hot flashes and vaginal dryness.

Nafarelin is a GnRH agonist that suppresses the secretion of GnRH.

Nafarelin is administered twice daily by nasal spray.

Nafarelin is administered intranasally.

DIF: Cognitive Level: Comprehension REF: 126


OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse
collects data about the client’s recent menstrual cycles. The nurse should collect additional
information with which statement?

a. The woman says her menstrual flow lasts 5 to 6 days.

b. She describes her flow as very heavy.

She reports that she has had a small amount of spotting midway between her periods for
c.
the past 2 months.

d. She says the length of her menstrual cycle varies from 26 to 29 days.

ANS: B

Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy


bleeding can have many causes. The amount of bleeding and its effect on daily activities should
be evaluated.

A menstrual flow that lasts 5 to 6 days is a normal finding.

Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14
days before onset of the next menses), is considered normal.

During her reproductive years a woman may have physiologic variations in her menstrual cycle.
Variations in the length of a menstrual cycle are considered normal.

DIF: Cognitive Level: Comprehension REF: 129

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment


5. Nurses who provide health care for women should recognize that the most commonly reported
gynecologic problem for women of any age-group is:

a. Dysmenorrhea

b. Menorrhagia

c. Dyspareunia

d. Endometriosis

ANS: A

Dysmenorrhea, or pain during or shortly before menstruation, is one of the most common
gynecologic problems in women of all ages.

Menorrhagia, or excessive bleeding, is an alteration in cyclic bleeding; it is not the most


commonly reported gynecologic problem.

Dyspareunia, or painful intercourse, is commonly associated with endometriosis.

Endometriosis is a type of menstrual disorder, but it is not the most commonly reported
gynecologic problem.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

6. When evaluating a client whose primary complaint is amenorrhea, the nurse must be aware that
lack of menstruation is most often the result of:
a. Stress

b. Excessive exercise

c. Pregnancy

d. Eating disorders

ANS: C

Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy.

Although stress may be a contributing factor to amenorrhea, pregnancy is the most common
cause.

Although excessive exercise may be a contributing factor to amenorrhea, pregnancy is the most
common cause.

Although eating disorders may be a contributing factor to amenorrhea, pregnancy is the most
common cause.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: “Nursing Process: Assessment, Diagnosis”

7. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for
this client, the nurse should know that:

a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy

b. Fibroids increase in size during the perimenopausal period

c. Menorrhagia is a common finding

d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus
ANS: C

The major symptoms associated with fibroids are menorrhagia and the physical effects produced
by large myomas.

Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown.

Fibroids are estrogen sensitive and shrink as levels of estrogen decline.

Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women.

DIF: Cognitive Level: Comprehension REF: 129

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. When assessing a woman for menopausal discomforts, the nurse would expect the woman to
describe the most frequently reported discomfort, which would be:

a. Headaches

b. Hot flashes

c. Mood swings

d. Vaginal dryness with dyspareunia

ANS: B

Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen
levels and is the most common disturbance of the perimenopausal woman.

Headaches may be associated with a decline in hormone levels; however, it is not the most
frequently reported discomfort for menopausal women.

Mood swings may be associated with a decline in hormone levels; however, it is not the most
frequently reported discomfort for menopausal women.
Vaginal dryness and dyspareunia may be associated with a decline in hormone levels; however,
it is not the most frequently reported discomfort for menopausal women.

DIF: Cognitive Level: Comprehension REF: 132

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

9. While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?

a. African-American race

b. Low protein intake

c. Obesity

d. Cigarette smoking

ANS: D

Smoking is associated with earlier and greater bone loss and decreased estrogen production.

Women at risk for osteoporosis are likely to be Caucasian or Asian.

Inadequate calcium intake is a risk factor for osteoporosis.

Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher
estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress
from extra weight also helps preserve bone mass.

DIF: Cognitive Level: Knowledge REF: 133

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment


10. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse
includes the risk of:

a. Breast cancer

b. Vaginal and urinary tract atrophy

c. Osteoporosis

d. Arteriosclerosis

ANS: A

Women with a high risk for breast cancer should be counseled against using ERT.

Estrogen prevents atrophy of vaginal and urinary tract tissue.

Estrogen protects against the development of osteoporosis.

Estrogen has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and
total cholesterol and increasing high-density lipoprotein (HDL). It also has a direct
antiatherosclerotic effect on the arteries.

DIF: Cognitive Level: Comprehension REF: 134

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

11. During her annual gynecologic checkup, a 17-year-old woman states that recently she has been
experiencing cramping and pain during her menstrual periods. The nurse documents this
complaint as:

a. Amenorrhea

b. Dysmenorrhea

c. Dyspareunia
d. Premenstrual syndrome (PMS)

ANS: B

Dysmenorrhea is pain during or shortly before menstruation.

Amenorrhea is the absence of menstrual flow.

Dyspareunia is pain during intercourse.

PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal
phase of the menstrual cycle and resolve within a couple of days of the onset of menses.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

12. The absence or cessation of menstrual flow is known as:

a. Amenorrhea

b. Dysmenorrhea

c. Menorrhagia

d. Metrorrhagia

ANS: A

Amenorrhea is most often the result of pregnancy, although it could be a sign of conditions that
require treatment.
Dysmenorrhea is painful menstruation that begins 2 to 6 months after menarche.

Menorrhagia is abnormally profuse or excessive bleeding from the uterus.

Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

13. With regard to dysmenorrhea, nurses should be aware that:

a. It is more common in older women

b. It is more common in leaner women who exercise strenuously

c. Symptoms can begin at any point in the ovulatory cycle

d. Pain usually occurs in the suprapubic area or lower abdomen

ANS: D

Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower
back or upper thighs.

Dysmenorrhea is more common in younger women ages 17 to 24.

Dysmenorrhea is more common in women who smoke and who are obese.

Symptoms begin with menstruation or sometimes a few hours before the onset of flow.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis


14. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?

Premenstrual dysphoric disorder (PDD) is a milder form of premenstrual syndrome and


a. more common in younger women.

Secondary dysmenorrhea is more intense and medically significant than primary


b.
dysmenorrhea.

Premenstrual syndrome is a complex, poorly understood condition that may include any
c.
of a hundred symptoms.

d. The causes of premenstrual syndrome (PMS) have been well established.

ANS: C

PMS may manifest itself with one or more of a hundred or so physical and psychologic
symptoms.

PDD is a more severe variant of PMS.

Secondary dysmenorrhea is characterized by more muted pain than that seen in primary
dysmenorrhea; the medical treatment is much the same.

The cause of PMS is unknown. It may in fact be a collection of different problems.


DIF: Cognitive Level: Comprehension REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

15. In helping a client manage premenstrual syndrome (PMS), the nurse should:

a. Recommend a diet with more body-building and energy food, such as red meat and sugar

b. Suggest herbal therapies, as well as yoga and massage

Tell the client to push for medications from the physician as soon as symptoms occur so
c.
as to lessen their severity

d. Discourage the use of diuretics

ANS: B

Herbal therapies, yoga, and massage have been reported to have a beneficial effect on PMS.

Limiting red meat, refined sugar, caffeinated beverages, and alcohol improves the diet and may
mitigate symptoms.

Medication usually is begun only if lifestyle changes fail to provide significant relief.

Natural diuretics may help reduce fluid retention.

DIF: Cognitive Level: Comprehension REF: 124

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning


16. With regard to endometriosis, nurses should be aware that:

a. It is characterized by the presence and growth of endometrial tissue inside the uterus

b. It is found more often in African-American women than in Caucasian or Asian women

It may worsen with repeated cycles or remain asymptomatic and disappear after
c.
menopause

d. It is unlikely to affect sexual intercourse or fertility

ANS: C

Symptoms vary among women, ranging from nonexistent to incapacitating.

With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women,
ranging from nonexistent to incapacitating.

Endometriosis is found equally in Caucasian and African-American women and is slightly more
prevalent in Asian women.

Women can experience painful intercourse and impaired fertility.

DIF: Cognitive Level: Knowledge REF: 125

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

17. One of the alterations in cyclic bleeding that occurs between periods is called:

a. Oligomenorrhea

b. Menorrhagia
c. Leiomyoma

d. Metrorrhagia

ANS: D

Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants.

Oligomenorrhea is infrequent or scanty menstruation.

Menorrhagia is excessive menstruation.

Leiomyoma is a common cause of excessive bleeding.

DIF: Cognitive Level: Knowledge REF: 127

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

18. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who
provides care for a client with this condition should be aware that the optimal pharmacologic
therapy for pain relief is:

a. Acetaminophen

b. Oral contraceptive pills (OCPs)

c. Nonsteroidal antiinflammatory drugs (NSAIDs)

d. Aspirin

ANS: C

NSAIDs have the strongest research results for pain relief. Often if one NSAID is not effective,
another one will provide relief. Approximately 80% of women find relief from these
prostaglandin inhibitors.
Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the
antiprostaglandin properties of NSAIDs.

OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the
reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women
and have a number of potential side effects.

NSAIDs are the drug of choice. However, if a woman is taking an NSAID she should avoid
taking aspirin as well.

DIF: Cognitive Level: Application REF: 122

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):

a. Soy

b. Vitamin C

c. Vitamin K

d. Vitamin E

e. Vitamin A

ANS: A, D

Both soy and vitamin E have been reported to help alleviate menopausal symptoms.

Vitamins C, K, and A have no apparent effect on menopausal symptoms.


DIF: Cognitive Level: Comprehension REF: 136

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.

a. Consume large quantities of caffeine

b. Drink a glass of wine

c. Eat Mexican food

d. Drink ice water

e. Drink warm beverages

ANS: D

Ice water may help alleviate the hot flashes.

Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or
drinking warm beverages most likely would exacerbate the hot flashes.

DIF: Cognitive Level: Comprehension REF: 137

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. Which medications can be taken by postmenopausal women to treat and/or prevent


osteoporosis? Choose all that apply.

a. Calcium

b. Evista
c. Fosamax

d. Actonel

e. Calcitonin

ANS: A, B, C, D, E

Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to
treat or prevent osteoporosis.

DIF: Cognitive Level: Comprehension REF: “139, 140”

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

4. Which statements might the nurse appropriately include when teaching a client about calcium
intake for osteoporosis? Choose all that apply.

a. “You should try to increase your protein intake when you are taking calcium.”

b. “It is best to take calcium in one large dose.”

c. “Tums are the most soluble form of calcium.”

“You should take calcium with vitamin D because the vitamin D helps your body absorb
d.
calcium better.”

e. “It’s okay to take calcium if you have had a history of kidney stones.”

ANS: C, D

Teaching the client to take calcium with vitamin D or to take calcium with a history of kidney
stones is accurate.
Excessive protein should be avoided. Calcium is best taken in divided doses so as to increase
absorption. Calcium should be taken with vitamin D to increase absorption. Calcium is
contraindicated in women with a history of kidney stones.

DIF: Cognitive Level: Application REF: 133

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

5. There is little consensus on the management of premenstrual dysphoric disorder (PMDD).


However, nurses can advise women on several self-help modalities that often result in symptom
improvement. The nurse knows that health teaching has been effective when the client reports
that she has adopted a number of lifestyle changes including:

a. Regular exercise

b. Improved nutrition

c. A daily glass of wine

d. Smoking cessation

e. Oil of evening primrose

ANS: A, B, D, E

Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are
accurate modalities that may provide significant symptom relief in 1 to 2 months. If there is no
improvement after these changes have been made, the client may need to begin pharmacologic
therapy.

Women should decrease their alcohol and caffeinated beverage consumption if they suffer from
PMDD.

DIF: Cognitive Level: Analysis REF: 124

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation


COMPLETION

1. Some plant foods contain _________________________ and are capable of interacting with
estrogen receptors in the body.

ANS:

Phytoestrogens

These foods include wild yams, dandelion greens, cherries, alfalfa sprouts, black beans, and
soybeans.

DIF: Cognitive Level: Knowledge REF: 136

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Any episode of vaginal bleeding that occurs at a time other than during menses is referred to as
_______________.

ANS:

Metrorrhagia

Defined as intermenstrual bleeding, this is also commonly referred to as breakthrough bleeding


or mittlestaining. This can be a normal part of a woman’s menstrual cycle if it occurs regularly or
it may be an indication of an underlying disease process that requires further investigation.

DIF: Cognitive Level: Knowledge REF: 127

OBJ: Client Needs: Health Promotion and Maintenance


TOP: Nursing Process: Assessment

TRUE/FALSE

1. Obese women are more likely to have dysfunctional uterine bleeding and endometrial
hyperplasia. Is this statement true or false?

ANS: T

Women with more body fat have higher circulating levels of estrone. This occurs because
estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is
available to the estrogen receptors within the endometrium.

DIF: Cognitive Level: Knowledge REF: 131

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

Chapter 07: Sexually Transmitted and Other Infections

Test Bank

MULTIPLE CHOICE

1. The two primary areas of risk for sexually transmitted infections (STIs) are:
a. Sexual orientation and socioeconomic status

b. Age and educational level

c. Large number of sexual partners and race

d. Risky sexual behaviors and inadequate preventive health behaviors

ANS: D

Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for
acquiring or transmitting an STI.

Although low socioeconomic status may be a factor in avoiding purchasing barrier protection,
sexual orientation does not put one at higher risk.

Younger individuals with less education may not be aware of proper prevention techniques;
however, these are not the primary areas for STIs.

Having a large number of sexual partners is certainly a risk-taking behavior, but race does not
increase the risk for STIs.

DIF: Cognitive Level: Knowledge REF: 144

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. The most common perinatal complications associated with bacterial sexually transmitted
infections (STIs) are:

a. Preterm labor and preterm birth

b. Newborn eye infections and low Apgar scores

c. Nausea, vomiting, and frequent urinary tract infections

d. Congenital anomalies and infertility


ANS: A

Risk factors associated with bacterial STIs include preterm labor and preterm birth, miscarriage,
and intrauterine growth restriction (IUGR).

Perinatal complications of bacterial gonorrhea may lead to newborn eye infections but not
necessarily to low Apgar scores.

Nausea, vomiting, and frequent urinary tract infections are not associated with bacterial STIs.

TORCH infections (which are not entirely sexually transmitted) are associated with congenital
anomalies. Untreated STIs may progress to pelvic inflammatory disease (PID) and infertility.

DIF: Cognitive Level: Knowledge REF: 162

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

3. When evaluating a client for sexually transmitted infections (STIs), the nurse should be aware
that the most common bacterial STI is:

a. Gonorrhea

b. Syphilis

c. Chlamydia

d. Candidiasis

ANS: C

Chlamydia is the most common and fastest spreading STI among American women, with an
estimated 3 million new cases each year.

Gonorrhea is a bacterial STI; however, it is not the most common among American women.

Syphilis is a bacterial STI; however, it is not the most common among American women.
Candidiasis is caused by a fungus, not by bacteria.

DIF: Cognitive Level: Knowledge REF: 146

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

4. The Centers for Disease Control and Prevention (CDC) recommends that human papillomavirus
(HPV) be treated with client-applied:

a. Miconazole ointment

b. Topical podofilox 0.5% solution or gel

c. Penicillin given intramuscularly for two doses

d. Metronidazole by mouth

ANS: B

Available treatments are imiquimod, podophyllin, and podofilox.

Miconazole ointment is used to treat athlete’s foot.

Penicillin IM is used to treat syphilis.

Metronidazole is used to treat bacterial vaginosis.

DIF: Cognitive Level: Knowledge REF: 148

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation


5. A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and
in her vagina. She complains of intense pruritus. The nurse practitioner orders which
preparation for treatment?

a. Fluconazole

b. Tetracycline

c. Clindamycin

d. Acyclovir

ANS: A

Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis.

Tetracycline is used to treat syphilis.

Clindamycin is used to treat bacterial vaginosis.

Acyclovir is used to treat genital herpes.

DIF: Cognitive Level: Comprehension REF: 161

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation


6. To detect the human immunodeficiency virus (HIV), most laboratory tests focus on:

a. HIV virus

b. HIV antibodies

c. CD4 counts

d. CD8 counts

ANS: B

The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence
of antibodies to the HIV.

In order to determine if the HIV is present, the test performed must be able to detect antibodies
to the virus, not the virus itself.

CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS)
in HIV-infected individuals.

CD8 counts are not performed in order to detect HIV.

DIF: Cognitive Level: Knowledge REF: 156

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

7. Which virus is most threatening to the fetus and neonate?

a. Hepatitis A virus

b. Herpes simplex virus (HSV)

c. Hepatitis B virus (HBV)

d. Cytomegalovirus (CMV)
ANS: C

HBV is the virus most threatening to the fetus and neonate.

Hepatitis A is not the most threatening to the fetus.

HSV is not the most threatening to the neonate.

Although serious, CMV is not the most threatening to the fetus.

DIF: Cognitive Level: Knowledge REF: 155

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Diagnosis

8. Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most
likely includes:

a. Oral antiviral therapy

b. Bed rest in a semi-Fowler position

c. Antibiotic regimen continued until symptoms subside

d. Frequent pelvic examination to monitor the progress of healing

ANS: B

The woman with acute PID should be on bed rest in a semi-Fowler position.

Broad-spectrum antibiotics are used.

Antibiotics must be taken as prescribed, even if symptoms subside.

Few pelvic examinations should be conducted during the acute phase of the disease.
DIF: Cognitive Level: Comprehension REF: 151

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

9. On vaginal examination of a 30-year-old woman, the nurse documents the following findings:
profuse, thin, grayish-white vaginal discharge with a “fishy” odor; complains of pruritus. Based
on these findings, the nurse suspects that this woman has:

a. Bacterial vaginosis

b. Candidiasis

c. Trichomoniasis

d. Gonorrhea

ANS: A

Most women with bacterial vaginosis (BV) complain of a characteristic “fishy odor.” The
discharge usually is profuse, thin, and has a white, gray, or milky color. Some women also may
have mild irritation or pruritus.

The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage
cheese.

Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish to


greenish, frothy, mucopurulent, copious, and malodorous discharge.

Women with gonorrhea are often asymptomatic. They may have a purulent endocervical
discharge, but discharge usually is minimal or absent.

DIF: Cognitive Level: Comprehension REF: 159

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment


10. Which viral sexually transmitted infection is characterized by a primary infection followed by
recurrent episodes?

a. Herpes simplex virus 2 (HSV-2)

b. Human papillomavirus (HPV)

c. Human immunodeficiency virus (HIV)

d. Cytomegalovirus (CMV)

ANS: A

The initial HSV genital infection is characterized by multiple painful lesions, fever, chills,
malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of HSV infection
commonly have only local symptoms that usually are less severe than those of the initial
infection.

With HPV infection, lesions are a chronic problem.

HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after
the virus has entered the body. Severe depression of the cellular immune system associated with
HIV infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure.

In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease
may become a chronic, persistent infection.

DIF: Cognitive Level: Comprehension REF: 153

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

11. The nurse should know that once the human immunodeficiency virus (HIV) enters the body,
seroconversion to HIV positivity usually occurs within:

a. 6 to 10 days
b. 2 to 4 weeks

c. 6 to 12 weeks

d. 6 months

ANS: C

Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered
the body.

Six to 10 days is too short a time period for seroconversion to HIV positivity to occur.

Two to 4 weeks is too short a time period for seroconversion to HIV positivity to occur.

Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered
the body; 6 months is too long.

DIF: Cognitive Level: Knowledge REF: 156

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

12. A 25-year-old single female comes to the gynecologist’s office for a follow-up visit related to her
abnormal Pap smear. The test revealed that the client has human papillomavirus (HPV). The
client asks, “What is that? Can you get rid of it?” Your best response is:

a. “It’s just a little lump on your cervix. We can just freeze it off.”

“HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection that may
b.
lead to cervical cancer.”

c. “HPV is a type of early human immunodeficiency virus. You will die from this.”

d. “You probably caught this from your current boyfriend. He should get tested for this.”
ANS: B

It is important to inform the client about STIs and the risks involved with HPV.

The health care team has a duty to provide proper information to the client, including
information related to sexually transmitted infections (STIs).

HPV and HIV are viruses that can be transmitted sexually, but they are not the same virus.

The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is
the initial symptom. The client may have had HPV before her current boyfriend. You cannot
make any deductions from this limited information.

DIF: Cognitive Level: Analysis REF: 152

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. Which sexually transmitted infection is not bacterial and thus not treatable with antibiotics?

a. Chlamydia

b. Gonorrhea

c. Genital herpes

d. Syphilis

ANS: C

Genital herpes is a viral infection and therefore does not respond to antibiotics.

Chlamydia is a bacterial infection and is treated with doxycycline or azithromycin.

Gonorrhea is a bacterial infection and is treated with any of several antibiotics.

Syphilis is a bacterial infection and is treated with penicillin.


DIF: Cognitive Level: Comprehension REF: 154

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

14. Which statement about the various forms of hepatitis is accurate?

a. A vaccine exists for hepatitis C but not for hepatitis B.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

c. Hepatitis B is less contagious than human immunodeficiency virus (HIV).

d. The incidence of hepatitis C is decreasing.

ANS: B

Contaminated milk and shellfish are common sources of infection with hepatitis A.

A vaccine exists for hepatitis B but not for hepatitis C.

Hepatitis B is more contagious than HIV.

The incidence of hepatitis C is increasing.

DIF: Cognitive Level: Knowledge REF: 155

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment


15. A saline wet smear (vaginal secretions mixed with normal saline on a glass slide) is the test for:

a. Bacterial vaginosis

b. Candidiasis

c. Yeast infection

d. Trichomoniasis

ANS: D

The presence of many white blood cell protozoa is a positive finding for trichomoniasis.

A normal saline test is used to test for bacterial vaginosis.

A potassium hydroxide preparation is used to test for candidiasis.

“Yeast infection” is the common name for candidiasis, for which the test is a potassium
hydroxide preparation.

DIF: Cognitive Level: Knowledge REF: 160

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

MULTIPLE RESPONSE

1. Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection
(STI) include (choose all that apply):

a. Fellatio

b. Unprotected anal intercourse


c. Multiple sex partners

d. Dry kissing

e. Abstinence

ANS: A, B, C

Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the
exposure risk and the possibility of acquiring an STI.

Dry kissing and abstinence are considered “safe” sexual practices.

DIF: Cognitive Level: Comprehension REF: 145

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. Which statements are true? Choose all that apply.

Human papillomavirus (HPV) infections are thought to be less common in pregnant


a. women than in women who are not pregnant.

HPV infections are thought to be more common in pregnant women than in women who
b.
are not pregnant.

c. HPV infection previously was called genital warts.

d. HPV infection previously was called herpes.

e. HPV may cause cancer.

ANS: B, C, E

HPV infections are thought to be more common in pregnant women, with an increase in
incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital
warts, is a sexually transmitted infection with more than 30 known serotypes, several of which
are associated with cervical cancer.

HPV infections are thought to be more common in pregnant women than in women who are not
pregnant. HPV formerly was called genital warts.

DIF: Cognitive Level: Comprehension REF: 152

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

3. A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital’s
maternity unit in labor. The client states that she has tested positive for human
immunodeficiency virus (HIV) but has not undergone any treatment during her pregnancy. As
her primary nurse you understand that the risk of perinatal transmission can be significantly
decreased by a number of prophylactic interventions. Select the appropriate interventions that
should be included in this client’s plan of care:

a. Intrapartum treatment with antiviral medications

b. Cesarean birth

c. Postpartum treatment with antiviral medications

d. Avoidance of breastfeeding

e. Pneumococcal, hepatitis B, and Haemophilus influenzae vaccine

ANS: A, B, D

The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding
reduce transmission as low as 1% to 2%. The client who refuses a cesarean birth should be given
antiviral therapy intravenously during labor.

Ideally, medications should be given prenatally. Administration of antiviral drugs in the


postpartum period will not reduce transmission to the infant. All women who are HIV positive
should be encouraged to receive these immunizations. They will not reduce the risk of perinatal
transmission.
DIF: Cognitive Level: Application REF: 157

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

COMPLETION

1. TORCH stands for:

T __________________

ANS: Toxoplasmosis

DIF: Cognitive Level: Comprehension REF: 163

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. TORCH stands for:

O _______________________

ANS: Other infections


DIF: Cognitive Level: Comprehension REF: 163

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. TORCH stands for:

R __________________

ANS: Rubella

DIF: Cognitive Level: Comprehension REF: 163

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. TORCH stands for:

C __________________

ANS:

Cytomegalovirus

CMV
DIF: Cognitive Level: Comprehension REF: 163

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

5. TORCH stands for:

H ___________________________

ANS: Herpes simplex virus

DIF: Cognitive Level: Comprehension REF: 163

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

6. The Jarisch-Herxheimer reaction is an acute febrile reaction associated with treatment for
__________________.

ANS: Syphilis

DIF: Cognitive Level: Knowledge REF: 150

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

TRUE/FALSE
1. Rates of syphilis in the United States among women, especially African-Americans, have
continued to rise since 2004. Is this statement true or false?

ANS: T

African-American women have the highest rate of syphilis among all ethnic groups in the United
States. In 2008 the rate was 36% higher than in 2007.

DIF: Cognitive Level: Knowledge REF: 149

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment