,
,Guidelines for Nurse Practitioners in Gynecologic Settings, 12th Edition
Testbank/Studyguide
Chapter1.Well-WomanInitial/AnnualGynecologicExam
1. Duetotheeffectsofcyclicovarianchangesinthebreast,whenisthebesttimeforbreastself-
examination(BSE)?
a. Between5and7daysaftermensesceases
b. Day1oftheendometrialcycle
c. Midmenstrualcycle
d. AnytimeduringashowerorbathAN
S:A
Thephysiologicalterationsinbreastsizeandactivityreachtheirminimallevelapproximately5
to7daysaftermenstruationceases.Therefore,BSEisbestperformedduringthisphaseofthemenstrualcy
cle.Day1oftheendometrialcycleistooearlytoperformanaccurateBSE.Afterthemidmenstrualcycle,br
eastsarelikelytobecometenderandincreaseinsize,whichisnottheidealtimetoperformBSE.Lyingdow
nafterashowerorbathwithasmalltowelundertheshoulderofthesidebeingexaminedisappropriateteach
ingforBSE.AsecondaryBSEmaybeperformedwhileintheshower.
2. Individualirregularitiesintheovarian(menstrual)cyclearemostoftencausedbywhat?
a. Variationsinthefollicular(preovulatory)phase
b. Intacthypothalamic-pituitaryfeedbackmechanism
c. Functioningcorpusluteum
d. Prolongedischemicphase
ANS:A
Almostallvariationsinthelengthoftheovariancyclearetheresultofvariationsinthelengthof
thefollicularphase.Anintacthypothalamic-
pituitaryfeedbackmechanismwouldberegular,notirregular.Thelutealphasebeginsafterovulation.Th
ecorpusluteumisdependentontheovulatoryphaseandfertilization.Duringtheischemicphase,thebloo
dsupplytothefunctionalendometriumisblocked,andnecrosisdevelops.Thefunctionallayerseparatesf
romthebasallayer,andmenstrualbleedingbegins.
3. Howwouldthephysiologicprocessofthesexualresponsebestbecharacterized?
a. Coitus,masturbation,andfantasy
b. Myotoniaandvasocongestion
c. Erectionandorgasm
d. Excitement,plateau,andorgasmA
NS:B
Physiologically,accordingtoMasters(1992),sexualresponsecanbeanalyzedintermsoftwo
processes:vasocongestionandmyotonia.Coitus,masturbation,andfantasyareformsofstimulationfort
hephysicalmanifestationofthesexualresponse.Erectionandorgasmoccurin
, twoofthefourphasesofthesexualresponsecycle.Excitement,plateau,andorgasmarethreeofthefourph
asesofthesexualresponsecycle.
4. Whichactionwouldbeinappropriateforthenursetoperformbeforebeginningthehealthhistoryi
nterview?
a. Smileandasktheclientwhethershehasanyspecialconcerns.
b. Speakinarelaxedmannerwithaneven,nonjudgmentaltone.
c. Maketheclientcomfortable.
d. Telltheclientherquestionsareirrelevant.AN
S:D
Thewomanshouldbeassuredthatallofherquestionsarerelevantandimportant.Beginningany
clientinteractionwithasmileisimportantandassistsinputtingtheclientatease.Ifthenursespeaksinarela
xedmanner,thentheclientwilllikelybemorerelaxedduringtheinterview.Theclientscomfortshouldal
waysbeensuredbeforebeginningtheinterview.
5. Thenurseguidesawomantotheexaminationroomandaskshertoremoveherclothesandputonane
xaminationgownwiththefrontopen.Thewomanreplies,IhavespecialundergarmentsthatIdonotre
moveforreligiousreasons.Whichisthemostappropriateresponsefromthenurse?
a. Youcanthaveanexaminationwithoutremovingallyourclothes.
b. Illaskthephysiciantomodifytheexamination.
Tellmeaboutyourundergarments.Illexplaintheexaminationprocedure,andthenwe
c. candiscusshowyoucancomfortablyhaveyourexamination.
d. Ihavenoideahowwecanaccommodateyourbeliefs.ANS:
C
Explainingtheexaminationprocedurereflectsculturalcompetencebythenurseandshows
respectforthewomansreligiouspractices.Thenursemustrespecttherichanduniquequalitiesthatcultur
aldiversitybringstoindividuals.Theexaminationcanbemodifiedtoensurethatmodestyismaintained.I
nrecognizingthevalueofculturaldifferences,thenursecanmodifytheplanofcaretomeettheneedsofeac
hwoman.Tellingtheclientthatherreligiouspracticesaredifferentorstrangeisinappropriateanddisresp
ectfultotheclient.
6. Awomanarrivesattheclinicforherannualexamination.Shetellsthenursethatshethinksshehasavagi
nalinfection,andshehasbeenusinganover-the-
countercreamforthepast2daystotreatit.Howshouldthenurseinitiallyrespond?
InformthewomanthatvaginalcreamsmayinterferewiththePapanicolaou(Pap)test
a. forwhichsheisscheduled.
b. Reassurethewomanthatusingvaginalcreamisnotaproblemfortheexamination.Askthe
womantodescribethesymptomsthatindicatetoherthatshehasavaginal
c. infection.
d. Askthewomantorescheduletheappointmentfortheexamination.ANS
:C
Animportantelementofthehealthhistoryandphysicalexaminationistheclientsdescriptionof
anysymptomsshemaybeexperiencing.Thebestresponseisforthenursetoinquireaboutthesymptomsthewo
manisexperiencing.Womenshouldnotdouche,usevaginalmedications,or
,Guidelines for Nurse Practitioners in Gynecologic Settings, 12th Edition
Testbank/Studyguide
Chapter1.Well-WomanInitial/AnnualGynecologicExam
1. Duetotheeffectsofcyclicovarianchangesinthebreast,whenisthebesttimeforbreastself-
examination(BSE)?
a. Between5and7daysaftermensesceases
b. Day1oftheendometrialcycle
c. Midmenstrualcycle
d. AnytimeduringashowerorbathAN
S:A
Thephysiologicalterationsinbreastsizeandactivityreachtheirminimallevelapproximately5
to7daysaftermenstruationceases.Therefore,BSEisbestperformedduringthisphaseofthemenstrualcy
cle.Day1oftheendometrialcycleistooearlytoperformanaccurateBSE.Afterthemidmenstrualcycle,br
eastsarelikelytobecometenderandincreaseinsize,whichisnottheidealtimetoperformBSE.Lyingdow
nafterashowerorbathwithasmalltowelundertheshoulderofthesidebeingexaminedisappropriateteach
ingforBSE.AsecondaryBSEmaybeperformedwhileintheshower.
2. Individualirregularitiesintheovarian(menstrual)cyclearemostoftencausedbywhat?
a. Variationsinthefollicular(preovulatory)phase
b. Intacthypothalamic-pituitaryfeedbackmechanism
c. Functioningcorpusluteum
d. Prolongedischemicphase
ANS:A
Almostallvariationsinthelengthoftheovariancyclearetheresultofvariationsinthelengthof
thefollicularphase.Anintacthypothalamic-
pituitaryfeedbackmechanismwouldberegular,notirregular.Thelutealphasebeginsafterovulation.Th
ecorpusluteumisdependentontheovulatoryphaseandfertilization.Duringtheischemicphase,thebloo
dsupplytothefunctionalendometriumisblocked,andnecrosisdevelops.Thefunctionallayerseparatesf
romthebasallayer,andmenstrualbleedingbegins.
3. Howwouldthephysiologicprocessofthesexualresponsebestbecharacterized?
a. Coitus,masturbation,andfantasy
b. Myotoniaandvasocongestion
c. Erectionandorgasm
d. Excitement,plateau,andorgasmA
NS:B
Physiologically,accordingtoMasters(1992),sexualresponsecanbeanalyzedintermsoftwo
processes:vasocongestionandmyotonia.Coitus,masturbation,andfantasyareformsofstimulationfort
hephysicalmanifestationofthesexualresponse.Erectionandorgasmoccurin
, twoofthefourphasesofthesexualresponsecycle.Excitement,plateau,andorgasmarethreeofthefourph
asesofthesexualresponsecycle.
4. Whichactionwouldbeinappropriateforthenursetoperformbeforebeginningthehealthhistoryi
nterview?
a. Smileandasktheclientwhethershehasanyspecialconcerns.
b. Speakinarelaxedmannerwithaneven,nonjudgmentaltone.
c. Maketheclientcomfortable.
d. Telltheclientherquestionsareirrelevant.AN
S:D
Thewomanshouldbeassuredthatallofherquestionsarerelevantandimportant.Beginningany
clientinteractionwithasmileisimportantandassistsinputtingtheclientatease.Ifthenursespeaksinarela
xedmanner,thentheclientwilllikelybemorerelaxedduringtheinterview.Theclientscomfortshouldal
waysbeensuredbeforebeginningtheinterview.
5. Thenurseguidesawomantotheexaminationroomandaskshertoremoveherclothesandputonane
xaminationgownwiththefrontopen.Thewomanreplies,IhavespecialundergarmentsthatIdonotre
moveforreligiousreasons.Whichisthemostappropriateresponsefromthenurse?
a. Youcanthaveanexaminationwithoutremovingallyourclothes.
b. Illaskthephysiciantomodifytheexamination.
Tellmeaboutyourundergarments.Illexplaintheexaminationprocedure,andthenwe
c. candiscusshowyoucancomfortablyhaveyourexamination.
d. Ihavenoideahowwecanaccommodateyourbeliefs.ANS:
C
Explainingtheexaminationprocedurereflectsculturalcompetencebythenurseandshows
respectforthewomansreligiouspractices.Thenursemustrespecttherichanduniquequalitiesthatcultur
aldiversitybringstoindividuals.Theexaminationcanbemodifiedtoensurethatmodestyismaintained.I
nrecognizingthevalueofculturaldifferences,thenursecanmodifytheplanofcaretomeettheneedsofeac
hwoman.Tellingtheclientthatherreligiouspracticesaredifferentorstrangeisinappropriateanddisresp
ectfultotheclient.
6. Awomanarrivesattheclinicforherannualexamination.Shetellsthenursethatshethinksshehasavagi
nalinfection,andshehasbeenusinganover-the-
countercreamforthepast2daystotreatit.Howshouldthenurseinitiallyrespond?
InformthewomanthatvaginalcreamsmayinterferewiththePapanicolaou(Pap)test
a. forwhichsheisscheduled.
b. Reassurethewomanthatusingvaginalcreamisnotaproblemfortheexamination.Askthe
womantodescribethesymptomsthatindicatetoherthatshehasavaginal
c. infection.
d. Askthewomantorescheduletheappointmentfortheexamination.ANS
:C
Animportantelementofthehealthhistoryandphysicalexaminationistheclientsdescriptionof
anysymptomsshemaybeexperiencing.Thebestresponseisforthenursetoinquireaboutthesymptomsthewo
manisexperiencing.Womenshouldnotdouche,usevaginalmedications,or
