Ricci Chapter 7 - Test Bank - 4th Edition Exam Questions And Answers

1. A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find? A. sporadic vaginal bleeding accompanied by chronic pelvic pain B. heavy leukorrhea with vulvar pruritus C. menstrual irregularities and hirsutism on the chin D. stress incontinence with feeling of low abdominal pressure - ANS Answer: D Rationale: Cystocele and rectocele are examples of pelvic organ prolapse. Manifestations typically include stress incontinence and lower abdominal pressure or pain. Complaints of sporadic vaginal bleeding and chronic pelvic pain are associated with uterine fibroids. Leukorrhea and vulvar pruritus commonly are associated with an infection. Menstrual irregularities and hirsutism are associated with polycystic ovarian syndrome. 2. To assist the woman in regaining control of the urinary sphincter after bladder surgery, the nurse should teach the client to perform which action? A. Perform Kegel exercises daily. B. Void every hour while awake. C. Limit the intake of fluid. D. Take a laxative every night. - ANS Answer: A Rationale: After bladder surgery, the client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended. 3. When developing the plan of care for a woman who has had an abdominal hysterectomy, the nurse would identify which action as contraindicated? A. ambulating the client B. massaging the client's legs C. applying elasticized stockings D. encouraging range-of-motion exercises - ANS Answer: B Rationale: After an abdominal hysterectomy, massaging the client's legs would be contraindicated because the woman is at risk for venous stasis, thrombophlebitis, and thromboembolism. Ambulation, elasticized stockings, and range-of-motion exercises would be appropriate to reduce the woman's risk for thrombophlebitis. 4. A nurse is conducting a presentation for a local women's group about pelvic floor disorders. Which instruction would the nurse include about preventing pelvic support disorders? A. performing Kegel isometric exercises B. consuming low-fiber diets C. using hormone replacement D. voiding every 2 hours - ANS Answer: A Rationale: Kegel exercises are an effective preventive measure for pelvic support disorders. They may limit the progression of a mild prolapse and alleviate mild prolapse symptoms. High-fiber rather than low-fiber diets are appropriate to reduce straining associated with constipation. Hormone replacement therapy must be highly individualized and is not an appropriate option for every woman. Normal voiding patterns typically are every 3 to 5 hours. Too frequent or too infrequent voiding can lead to problems. 5. A client is diagnosed with an enterocele. The nurse interprets this condition as: A. protrusion of the posterior bladder wall downward through the anterior vaginal wall. B. sagging of the rectum with pressure exerted against the posterior vaginal wall. C. bulging of the small intestine through the posterior vaginal wall. D. descent of the uterus through the pelvic floor into the vagina. - ANS Answer: C Rationale: An enterocele occurs when the small intestine bulges through the posterior vaginal wall, especially when straining. A cystocele is a protrusion of the posterior bladder wall downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes against or into the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal. 6. A woman is scheduled for an anterior and posterior colporrhaphy as treatment for a cystocele. When the nurse is explaining this treatment to the client, which description would be most appropriate to include? A. "This procedure helps to tighten the vaginal wall in the front and back so that your bladder and urethra are in the proper position." B. "Your uterus will be removed through your vagina, helping to relieve the organ that is putting the pressure on your bladder." C. "This is a series of exercises that you will learn to do so that you can strengthen your bladder muscles." D. "These are plastic devices that your primary care provider will insert into your vagina to provide support to the uterus and keep it in the proper position." - ANS Answer: A Rationale: An anterior and posterior colporrhaphy tightens the anterior and posterior vaginal wall, and the supportive tissue between the vagina and bladder is folded and sutured to bring the bladder and urethra into proper position. Removal of the uterus through the vagina refers to a vaginal hysterectomy. Exercises to strengthen the bladder muscles are called Kegel exercises. Plastic devices inserted to provide support are called pessaries. 7. A client is diagnosed with uterine fibroids. When reviewing the client's health history, the nurse would identify which finding as associated with the client's condition? A. diarrhea B. chronic pelvic pain C. amenorrhea D. upper back pain - ANS Answer: B Rationale: Findings associated with uterine fibroids include chronic pelvic pain, constipation, dysmenorrhea, and lower back pain. 8. A client with polycystic ovarian syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. When discussing this treatment with the client, the nurse would discuss which rationale for this therapy? A. restore menstrual regularity B. induce ovulation C. improve insulin uptake D. alleviate hirsutism - ANS Answer: A Rationale: Oral contraceptives are used as treatment for PCOS to restore menstrual irregularities and treat acne. Ovulation induction agents such as clomiphene are used to induce ovulation. Metformin is used to improve insulin uptake. Mechanical hair removal methods are used to treat hirsutism. 9. When teaching a woman how to perform Kegel exercises, the client asks what muscles are being helped with these exercises. The nurse would include reference to which muscles in the response? A. gluteus B. lower abdominal C. pelvic floor D. diaphragmatic - ANS Answer: C Rationale: Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse. They have no effect on the gluteal, lower abdominal, or diaphragmatic muscles. 10. A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? A. increased vaginal discharge B. urinary tract infection C. vaginitis D. vaginal ulceration - ANS Answer: D Rationale: Use of a pessary can lead to pressure necrosis. Postmenopausal women with thin vaginal mucosa are highly susceptible to vaginal ulceration. Increased vaginal discharge, urinary tract infections, and vaginitis are possible side effects that could be seen in any woman fitted with a pessary. 11. When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which information would the nurse include? A. care of the indwelling catheter at home B. emphasis on coughing to prevent complications C. return to usual activity level in a few days D. daily douching with dilute vinegar solution - ANS Answer: A Rationale: Following surgery to repair a pelvic organ prolapse, the nurse would teach the woman about caring for the indwelling catheter, which will remain in place for approximately 1 week. Activities that increase intra-abdominal pressure, such as straining, sneezing, or coughing, should be avoided. The woman also should avoid heavy lifting or straining for several weeks. Pelvic rest is prescribed until the operative area is healed in 6 weeks. Douching is indicated if the woman had a pessary inserted, not surgery. 12. A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head, but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would the nurse identify as the priority? A. situational low self-esteem related to masculinization effects of the disease B. social isolation related to feelings about appearance C. risk for suicide related to effects of condition and fluctuating hormone levels D. ineffective peripheral tissue perfusion related to effects of disease on vasculature - ANS Answer: A Rationale: The woman is verbalizing how she sees herself in light of the manifestations of PCOS. She is exhibiting a negative self-image. Therefore, the nursing diagnosis of situational low self-esteem would be a priority. There is no information about the woman's participation in social activities. Her statements do not reflect that she might hurt herself. PCOS is associated with long-term health problems, but this is not evidenced by the scenario. 13. After teaching a local woman's group about incontinence, the nurse determines that the teaching was successful when the group identifies which characteristic of stress incontinence? A. feeling a strong need to void B. passing a large amount of urine C. developing most often in women in their 30s D. sneezing as an initiating stimulus - ANS Answer: D Rationale: Stress incontinence is characterized by the involuntary passage of a small amount of urine in response to an increase in intra-abdominal pressure, such as with sneezing, coughing, laughing, or physical exertion. It develops commonly in women in their 40s and 50s due to the weakening of the muscles and the ligaments in the pelvis after birth.