,Guidelines for Nurse Practitioners in Gynecologic Settings, 12th Edition
g g g g g g g g
Testbank/Studyguide g
Chapter 1. Well-Woman Initial/Annual Gynecologic Exam
g g g g g
1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self-
g g g g g g g g g g g g g g g g g g
examination (BSE)?
g g
a. Between 5 and 7 days after menses ceases g g g g g g g
b. Day 1 of the endometrial cycle
g g g g g
c. Midmenstrual cycle g
d. Any time during a shower or bath g g g g g g
gANS: A g
The physiologic alterations in breast size and activity reach their minimal level approximately 5
g g g g g g g g g g g g g
to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the
g g g g g g g g g g g g g g g
gmenstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After
g g g g g g g g g g g g g g g g
gthe midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the
g g g g g g g g g g g g g g g g
gideal time to perform BSE. Lying down after a shower or bath with a small towel under the
g g g g g g g g g g g g g g g g g
gshoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be
g g g g g g g g g g g g g g g
gperformed while in the shower. g g g g
2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
g g g g g g g g g g g g
a. Variations in the follicular (preovulatory) phase g g g g g
b. Intact hypothalamic-pituitary feedback mechanism
g g g
c. Functioning corpus luteum g g
d. Prolonged ischemic phase g g
gANS: A g
Almost all variations in the length of the ovarian cycle are the result of variations in the length of
g g g g g g g g g g g g g g g g g g
the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not
g g g g g g g g g g g
girregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the
g g g g g g g g g g g g g
govulatory phase and fertilization. During the ischemic phase, the blood supply to the functional
g g g g g g g g g g g g g
gendometrium is blocked, and necrosis develops. The functional layer separates from the basal
g g g g g g g g g g g g
glayer, and menstrual bleeding begins.
g g g g
3. How would the physiologic process of the sexual response best be characterized?
g g g g g g g g g g g
a. Coitus, masturbation, and fantasy g g g
b. Myotonia and vasocongestion g g
c. Erection and orgasm g g
d. Excitement, plateau, and orgasm g g g
ANS: B
g g
Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two
g g g g g g g g g g g g g
processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of
g g g g g g g g g g
stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in
g g g g g g g g g g g g g g
,two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of
g g g g g g g g g g g g g g g g
gthe four phases of the sexual response cycle.
g g g g g g g
4. Which action would be inappropriate for the nurse to perform before beginning the health
g g g g g g g g g g g g g
ghistory interview? g
a. Smile and ask the client whether she has any special concerns. g g g g g g g g g g
b. Speak in a relaxed manner with an even, nonjudgmental tone.
g g g g g g g g g
c. Make the client comfortable. g g g
d. Tell the client her questions are irrelevant. g g g g g g
ANS: D
g g
The woman should be assured that all of her questions are relevant and important. Beginning any
g g g g g g g g g g g g g g g
client interaction with a smile is important and assists in putting the client at ease. If the nurse
g g g g g g g g g g g g g g g g g
speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The
g g g g g g g g g g g g g g g g g
clients comfort should always be ensured before beginning the interview.
g g g g g g g g g g
5. The nurse guides a woman to the examination room and asks her to remove her clothes and
g g g g g g g g g g g g g g g g
put on an examination gown with the front open. The woman replies, I have special
g g g g g g g g g g g g g g g
undergarments that I do not remove for religious reasons. Which is the most appropriate
g g g g g g g g g g g g g g
response from the nurse?
g g g g
a. You cant have an examination without removing all your clothes. g g g g g g g g g
b. Ill ask the physician to modify the examination.
g g g g g g g
Tell me about your undergarments. Ill explain the examination procedure, and then we
g g g g g g g g g g g g
c. can discuss how you can comfortably have your examination.
g g g g g g g g
d. I have no idea how we can accommodate your beliefs.
g g g g g g g g g
ANS: C
g g
Explaining the examination procedure reflects cultural competence by the nurse and shows
g g g g g g g g g g g
respect for the womans religious practices. The nurse must respect the rich and unique qualities
g g g g g g g g g g g g g g
that cultural diversity brings to individuals. The examination can be modified to ensure that
g g g g g g g g g g g g g g
modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the
g g g g g g g g g g g g g g g
plan of care to meet the needs of each woman. Telling the client that her religious practices are
g g g g g g g g g g g g g g g g g g
different or strange is inappropriate and disrespectful to the client.
g g g g g g g g g g
6. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks
g g g g g g g g g g g g g g g g
she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days
g g g g g g g g g g g g g g g g g g
to treat it. How should the nurse initially respond?
g g g g g g g g g
Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test g g g g g g g g g g g g
a. for which she is scheduled. g g g g
b. Reassure the woman that using vaginal cream is not a problem for the examination.
g g g g g g g g g g g g g
gAsk the woman to describe the symptoms that indicate to her that she has a vaginal
g g g g g g g g g g g g g g g
c. infection.
d. Ask the woman to reschedule the appointment for the examination. g g g g g g g g g
ANS: C
g g
An important element of the health history and physical examination is the clients description of
g g g g g g g g g g g g g g
any symptoms she may be experiencing. The best response is for the nurse to inquire about the
g g g g g g g g g g g g g g g g
symptoms the woman is experiencing. Women should not douche, use vaginal medications, or
g g g g g g g g g g g g g
, have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may
g g g g g g g g g g g g g g g g
need to reschedule a visit for her Pap test, her current symptoms should still be addressed.
g g g g g g g g g g g g g g g g
7. Preconception and prenatal care have become important components of womens health. What
g g g g g g g g g g g
is the guiding principal of preconception care?
g g g g g g g
a. Ensure that pregnancy complications do not occur. g g g g g g
b. Identify the woman who should not become pregnant. g g g g g g g
c. Encourage healthy lifestyles for families desiring pregnancy. g g g g g g
d. Ensure that women know about prenatal care. g g g g g g
gANS: C g
Preconception counseling guides couples in how to avoid unintended pregnancies, how to
g g g g g g g g g g g
identify and manage risk factors in their lives and in their environment, and how to identify
g g g g g g g g g g g g g g g
ghealthy behaviors that promote the well-being of the woman and her potential fetus.
g g g g g g g g g g g g
Preconception care does not ensure that pregnancy complications will not occur. In many cases,
g g g g g g g g g g g g g
gproblems can be identified and treated and may not recur in subsequent pregnancies. For many
g g g g g g g g g g g g g g
gwomen, counseling can allow behavior modification before any damage is done, or a woman can
g g g g g g g g g g g g g g
gmake an informed decision about her willingness to accept potential hazards. If a woman is
g g g g g g g g g g g g g g
gseeking preconception care, then she is likely aware of prenatal care.
g g g g g g g g g g
8. Ovarian function and hormone production decline during which transitional phase?
g g g g g g g g g
a. Climacteric
b. Menarche
c. Menopause
d. Puberty
ANS: A
g g
The climacteric phase is a transitional period during which ovarian function and hormone
g g g g g g g g g g g g
production decline. Menarche is the term that denotes the first menstruation. Menopause refers
g g g g g g g g g g g g
only to the last menstrual period.Puberty is a broad term that denotes the entire transitional
g g g g g g g g g g g g g g g
period between childhood and sexual maturity.
g g g g g g
9. Which statement indicates that a client requires additional instruction regarding BSE?
g g g g g g g g g g
a. Yellow discharge from my nipple is normal if Im having my period. g g g g g g g g g g g
b. I should check my breasts at the same time each month, after my period.
g g g g g g g g g g g g g
c. I should also feel in my armpit area while performing my breast examination.
g g g g g g g g g g g g
d. I should check each breast in a set way, such as in a circular motion.
g g g g g g g g g g g g g g
ANS: A
g g
Discharge from the nipples requires further examination from a health care provider. The breasts
g g g g g g g g g g g g g
should be checked at the same time each month. The armpit should also be examined. A circular
g g g g g g g g g g g g g g g g
motion is the best method during which to ascertain any changes in the breast tissue.
g g g g g g g g g g g g g g g
10. A blind woman has arrived for an examination. Her guide dog assists her to the examination
g g g g g g g g g g g g g g g
room. She appears nervous and says, Ive never had a pelvic examination. What response from
g g g g g g g g g g g g g g g
the nurse would be most appropriate?
g g g g g g
a. Dont worry. It will be over before you know it. g g g g g g g g g
b. Try to relax. Ill be very gentle, and I wont hurt you.
g g g g g g g g g g g
g g g g g g g g
Testbank/Studyguide g
Chapter 1. Well-Woman Initial/Annual Gynecologic Exam
g g g g g
1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self-
g g g g g g g g g g g g g g g g g g
examination (BSE)?
g g
a. Between 5 and 7 days after menses ceases g g g g g g g
b. Day 1 of the endometrial cycle
g g g g g
c. Midmenstrual cycle g
d. Any time during a shower or bath g g g g g g
gANS: A g
The physiologic alterations in breast size and activity reach their minimal level approximately 5
g g g g g g g g g g g g g
to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the
g g g g g g g g g g g g g g g
gmenstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After
g g g g g g g g g g g g g g g g
gthe midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the
g g g g g g g g g g g g g g g g
gideal time to perform BSE. Lying down after a shower or bath with a small towel under the
g g g g g g g g g g g g g g g g g
gshoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be
g g g g g g g g g g g g g g g
gperformed while in the shower. g g g g
2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
g g g g g g g g g g g g
a. Variations in the follicular (preovulatory) phase g g g g g
b. Intact hypothalamic-pituitary feedback mechanism
g g g
c. Functioning corpus luteum g g
d. Prolonged ischemic phase g g
gANS: A g
Almost all variations in the length of the ovarian cycle are the result of variations in the length of
g g g g g g g g g g g g g g g g g g
the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not
g g g g g g g g g g g
girregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the
g g g g g g g g g g g g g
govulatory phase and fertilization. During the ischemic phase, the blood supply to the functional
g g g g g g g g g g g g g
gendometrium is blocked, and necrosis develops. The functional layer separates from the basal
g g g g g g g g g g g g
glayer, and menstrual bleeding begins.
g g g g
3. How would the physiologic process of the sexual response best be characterized?
g g g g g g g g g g g
a. Coitus, masturbation, and fantasy g g g
b. Myotonia and vasocongestion g g
c. Erection and orgasm g g
d. Excitement, plateau, and orgasm g g g
ANS: B
g g
Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two
g g g g g g g g g g g g g
processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of
g g g g g g g g g g
stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in
g g g g g g g g g g g g g g
,two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of
g g g g g g g g g g g g g g g g
gthe four phases of the sexual response cycle.
g g g g g g g
4. Which action would be inappropriate for the nurse to perform before beginning the health
g g g g g g g g g g g g g
ghistory interview? g
a. Smile and ask the client whether she has any special concerns. g g g g g g g g g g
b. Speak in a relaxed manner with an even, nonjudgmental tone.
g g g g g g g g g
c. Make the client comfortable. g g g
d. Tell the client her questions are irrelevant. g g g g g g
ANS: D
g g
The woman should be assured that all of her questions are relevant and important. Beginning any
g g g g g g g g g g g g g g g
client interaction with a smile is important and assists in putting the client at ease. If the nurse
g g g g g g g g g g g g g g g g g
speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The
g g g g g g g g g g g g g g g g g
clients comfort should always be ensured before beginning the interview.
g g g g g g g g g g
5. The nurse guides a woman to the examination room and asks her to remove her clothes and
g g g g g g g g g g g g g g g g
put on an examination gown with the front open. The woman replies, I have special
g g g g g g g g g g g g g g g
undergarments that I do not remove for religious reasons. Which is the most appropriate
g g g g g g g g g g g g g g
response from the nurse?
g g g g
a. You cant have an examination without removing all your clothes. g g g g g g g g g
b. Ill ask the physician to modify the examination.
g g g g g g g
Tell me about your undergarments. Ill explain the examination procedure, and then we
g g g g g g g g g g g g
c. can discuss how you can comfortably have your examination.
g g g g g g g g
d. I have no idea how we can accommodate your beliefs.
g g g g g g g g g
ANS: C
g g
Explaining the examination procedure reflects cultural competence by the nurse and shows
g g g g g g g g g g g
respect for the womans religious practices. The nurse must respect the rich and unique qualities
g g g g g g g g g g g g g g
that cultural diversity brings to individuals. The examination can be modified to ensure that
g g g g g g g g g g g g g g
modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the
g g g g g g g g g g g g g g g
plan of care to meet the needs of each woman. Telling the client that her religious practices are
g g g g g g g g g g g g g g g g g g
different or strange is inappropriate and disrespectful to the client.
g g g g g g g g g g
6. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks
g g g g g g g g g g g g g g g g
she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days
g g g g g g g g g g g g g g g g g g
to treat it. How should the nurse initially respond?
g g g g g g g g g
Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test g g g g g g g g g g g g
a. for which she is scheduled. g g g g
b. Reassure the woman that using vaginal cream is not a problem for the examination.
g g g g g g g g g g g g g
gAsk the woman to describe the symptoms that indicate to her that she has a vaginal
g g g g g g g g g g g g g g g
c. infection.
d. Ask the woman to reschedule the appointment for the examination. g g g g g g g g g
ANS: C
g g
An important element of the health history and physical examination is the clients description of
g g g g g g g g g g g g g g
any symptoms she may be experiencing. The best response is for the nurse to inquire about the
g g g g g g g g g g g g g g g g
symptoms the woman is experiencing. Women should not douche, use vaginal medications, or
g g g g g g g g g g g g g
, have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may
g g g g g g g g g g g g g g g g
need to reschedule a visit for her Pap test, her current symptoms should still be addressed.
g g g g g g g g g g g g g g g g
7. Preconception and prenatal care have become important components of womens health. What
g g g g g g g g g g g
is the guiding principal of preconception care?
g g g g g g g
a. Ensure that pregnancy complications do not occur. g g g g g g
b. Identify the woman who should not become pregnant. g g g g g g g
c. Encourage healthy lifestyles for families desiring pregnancy. g g g g g g
d. Ensure that women know about prenatal care. g g g g g g
gANS: C g
Preconception counseling guides couples in how to avoid unintended pregnancies, how to
g g g g g g g g g g g
identify and manage risk factors in their lives and in their environment, and how to identify
g g g g g g g g g g g g g g g
ghealthy behaviors that promote the well-being of the woman and her potential fetus.
g g g g g g g g g g g g
Preconception care does not ensure that pregnancy complications will not occur. In many cases,
g g g g g g g g g g g g g
gproblems can be identified and treated and may not recur in subsequent pregnancies. For many
g g g g g g g g g g g g g g
gwomen, counseling can allow behavior modification before any damage is done, or a woman can
g g g g g g g g g g g g g g
gmake an informed decision about her willingness to accept potential hazards. If a woman is
g g g g g g g g g g g g g g
gseeking preconception care, then she is likely aware of prenatal care.
g g g g g g g g g g
8. Ovarian function and hormone production decline during which transitional phase?
g g g g g g g g g
a. Climacteric
b. Menarche
c. Menopause
d. Puberty
ANS: A
g g
The climacteric phase is a transitional period during which ovarian function and hormone
g g g g g g g g g g g g
production decline. Menarche is the term that denotes the first menstruation. Menopause refers
g g g g g g g g g g g g
only to the last menstrual period.Puberty is a broad term that denotes the entire transitional
g g g g g g g g g g g g g g g
period between childhood and sexual maturity.
g g g g g g
9. Which statement indicates that a client requires additional instruction regarding BSE?
g g g g g g g g g g
a. Yellow discharge from my nipple is normal if Im having my period. g g g g g g g g g g g
b. I should check my breasts at the same time each month, after my period.
g g g g g g g g g g g g g
c. I should also feel in my armpit area while performing my breast examination.
g g g g g g g g g g g g
d. I should check each breast in a set way, such as in a circular motion.
g g g g g g g g g g g g g g
ANS: A
g g
Discharge from the nipples requires further examination from a health care provider. The breasts
g g g g g g g g g g g g g
should be checked at the same time each month. The armpit should also be examined. A circular
g g g g g g g g g g g g g g g g
motion is the best method during which to ascertain any changes in the breast tissue.
g g g g g g g g g g g g g g g
10. A blind woman has arrived for an examination. Her guide dog assists her to the examination
g g g g g g g g g g g g g g g
room. She appears nervous and says, Ive never had a pelvic examination. What response from
g g g g g g g g g g g g g g g
the nurse would be most appropriate?
g g g g g g
a. Dont worry. It will be over before you know it. g g g g g g g g g
b. Try to relax. Ill be very gentle, and I wont hurt you.
g g g g g g g g g g g
