Chapter 53: Female Reproductive and Genital Problems Lewis: Medical -
Surgical Nursing Test Bank A 34 -yr-old patient who is discussing contraceptive options with the nurse says, "I want to have children but not for a few years." Which response by the n urse is accurate? a. "If you do not become pregnant within the next few years, you never will." b. "Women often have more difficulty becoming pregnant after about age 35." c. "Stop taking oral contraceptives several years before you want to have a child." d. "You have many more years of fertility left, so there is no rush to have children." - ANS: B The probability of successfully becoming pregnant decreases after age 35 y ears, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indica te that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving. DIF: Cognitive Level: Apply (application) REF: 1242 TOP: Nursing Process: Imp lementation MSC: NCLEX: Health Promotion and Maintenance The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which nursing diagnosis is appropriate? a. Decisional conflict related to inadequate financial resources b. Ineffective sexuality patterns related to psychological stress c. Defensive coping related to anxiety about lack of conception d. Ineffective denial related to frustration about continued infertility - ANS: C The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexua lity and ineffective denial are problems. Although the couple is quarreling about finances, the data do not provide information indicating that the finances are inadequate. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Diagnosi s MSC: NCLEX: Psychosocial Integrity (Page 519). A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that a. ovulation is unpredictable unless there are regular menstru al periods. b. ovulation prediction kits can provide accurate information about ovulation. c. she will need to bring a specimen of cervical mucus to the clinic for testing. d. she should take her body temperature daily and have intercourse when it drops . - ANS: B Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance . A patient has an induced abortion with s uction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient? a. "Avoid contraceptives until your reexamination." b. "Heavy vaginal bleeding is expected for 2 weeks." c. "Abstain from sexual intercourse for the next 2 weeks." d. "Irregular menstrual periods are expected for a few months." - ANS: C Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reex amination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss wi th the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in term inating the pregnancy. - ANS: B Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termina tion will not be successful. General anesthesia is not needed for this procedure. DIF: Cognitive Level: Apply (application) REF: 1244 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance A 28 -yr-old patient reports anxiety, h eadaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aer obic exercise to decrease her symptoms. c. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control sympto ms. - ANS: A The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS.
Surgical Nursing Test Bank A 34 -yr-old patient who is discussing contraceptive options with the nurse says, "I want to have children but not for a few years." Which response by the n urse is accurate? a. "If you do not become pregnant within the next few years, you never will." b. "Women often have more difficulty becoming pregnant after about age 35." c. "Stop taking oral contraceptives several years before you want to have a child." d. "You have many more years of fertility left, so there is no rush to have children." - ANS: B The probability of successfully becoming pregnant decreases after age 35 y ears, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indica te that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving. DIF: Cognitive Level: Apply (application) REF: 1242 TOP: Nursing Process: Imp lementation MSC: NCLEX: Health Promotion and Maintenance The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which nursing diagnosis is appropriate? a. Decisional conflict related to inadequate financial resources b. Ineffective sexuality patterns related to psychological stress c. Defensive coping related to anxiety about lack of conception d. Ineffective denial related to frustration about continued infertility - ANS: C The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexua lity and ineffective denial are problems. Although the couple is quarreling about finances, the data do not provide information indicating that the finances are inadequate. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Diagnosi s MSC: NCLEX: Psychosocial Integrity (Page 519). A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that a. ovulation is unpredictable unless there are regular menstru al periods. b. ovulation prediction kits can provide accurate information about ovulation. c. she will need to bring a specimen of cervical mucus to the clinic for testing. d. she should take her body temperature daily and have intercourse when it drops . - ANS: B Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance . A patient has an induced abortion with s uction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient? a. "Avoid contraceptives until your reexamination." b. "Heavy vaginal bleeding is expected for 2 weeks." c. "Abstain from sexual intercourse for the next 2 weeks." d. "Irregular menstrual periods are expected for a few months." - ANS: C Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reex amination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss wi th the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in term inating the pregnancy. - ANS: B Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termina tion will not be successful. General anesthesia is not needed for this procedure. DIF: Cognitive Level: Apply (application) REF: 1244 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance A 28 -yr-old patient reports anxiety, h eadaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aer obic exercise to decrease her symptoms. c. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control sympto ms. - ANS: A The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS.
