Lewis Test Bank
1. The nurse in the women's health clinic has four patients who are waiting to be seen. Which
patient should the nurse see FIRST?: a. 22-year-old with persistent red-brown vaginal drainage 3
days after having balloon thermotherapy
b. 42-year-old with secondary amenorrhea who says that her last menstrual cycle was 3 months ago
c. 35-year-old with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month
ago
D. 19-year-old with menorrhagia who has been using superabsorbent tampons and has fever with
weakness Rational:
The patients history and clinical manifestations suggest possible toxic shock syn- drome, which will
require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and
do not indicate life-threatening complications.
2. A healthy 28-year-old who has been vaccinated against human papillo- mavirus (HPV) has a
normal Pap test. Which information will the nurse include in patient teaching when calling the
patient with the results of the Pap test?-
: Pap testing is recommended every 3 years for women your age.
3. To prevent pregnancy in a patient who has been sexually assaulted, the nurse in the
emergency department will plan to teach the patient about the use of: levonorgestrel (Plan-B
One-Step).
Rational:
Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of inter- course. The other
methods are used for therapeutic abortion, but not for pregnancy prevention after unprotected
intercourse.
4. A 22-year-old tells the nurse that she has not had a menstrual period for the last 2 months.
Which action is MOST important for the nurse to take?: A. Obtain a urine specimen for a
pregnancy test.
b. Ask about any recent stressful lifestyle changes.
c. Measure the patients current height and weight.
d. Question the patient about prescribed medications. Rational:
, Lewis Test Bank
Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age.
The other actions are also appropriate, but it is important to check for pregnancy in this patient because
pregnancy will require rapid implemen- tation of actions to promote normal fetal development such as
changes in lifestyle, folic acid intake, etc.
5. Which information will the nurse include when teaching a patient who has developed a
small vesicovaginal fistula 2 weeks into the postpartum period?: a. Take stool softeners to
prevent fecal contamination of the vagina.
b. Limit oral fluid intake to minimize the quantity of urinary drainage.
C. Change the perineal pad frequently to prevent perineal skin breakdown.
d. Call the health care provider immediately if urine drains from the vagina. Rational:
Because urine will leak from the bladder, the patient should plan to use perineal pads and change them
frequently. A high fluid intake is recommended to decrease the risk for urinary tract infections.
Drainage of urine from the vagina is expected with vesicovaginal fistulas. Fecal contamination is not a
concern with vesicovaginal fistulas.
6. The nurse has just received change-of-shift report about the following four patients. Which
patient should be assessed FIRST?: a. A patient with a cervical radium implant in place who is crying
in her room
b. A patient who is complaining of 5/10 pain after an abdominal hysterectomy
C. A patient with a possible ectopic pregnancy who is complaining of shoulder pain
d. A patient in the fifteenth week of gestation who has uterine cramping and spotting Rational:
The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate
assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be
assessed as quickly as possible but do not have symptoms of life-threatening complications
7. A 27-year-old patient tells the nurse that she would like a prescription for oral contraceptives
to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information
is MOST important to communicate to the health care provider?: a. Bilateral breast tenderness
b. Frequent abdominal bloating
C. History of migraine headaches
d. Previous spontaneous abortion Rational:
, Lewis Test Bank
Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other
patient information would not prevent the patient from receiv- ing oral contraceptives.
8. The nurse notes that a patient who has a large cystocele, admitted 10 hours ago, has not yet
voided. Which action should the nurse take FIRST?: a. Insert a straight catheter per the PRN order.
b. Encourage the patient to increase oral fluids.
c. Notify the health care provider of the inability to void. D. Use an ultrasound scanner to check for
urinary retention.
Rational:
Because urinary retention is common with a large cystocele, the nurses first action should be to use an
ultrasound bladder scanner to check for the presence of urine
in the bladder. The other actions may be appropriate, depending on the findings with the bladder
scanner.
9. A 58-year-old patient who has undergone a radical vulvectomy for vulvar carcinoma returns
to the medical-surgical unit after the surgery. The PRIORITY nursing diagnosis for the patient at
this time is: A. risk for infection related to contact of the wound with urine and stool.
b. self-care deficit: bathing/hygiene related to pain and difficulty moving.
c. imbalanced nutrition: less than body requirements related to low-residue diet.
d. risk for ineffective sexual pattern related to disfiguration caused by the surgery. Rational:
Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The
other nursing diagnoses may also be appropriate for the patient but are not the highest priority
immediately after surgery.
10.A 32-year-old woman brought to the emergency department reports being sexually assaulted.
The patient is confused about where she is and she has a large laceration above the right eye.
Which action should the nurse take FIRST?: A. Assess the patients neurologic status.
b. Assist the patient to remove her clothing.
c. Contact the sexual assault nurse examiner (SANE).
d. Ask the patient to describe what occurred during the assault. Rational:
The first priority is to treat urgent medical problems associated with the sexual assault. The patients
1. The nurse in the women's health clinic has four patients who are waiting to be seen. Which
patient should the nurse see FIRST?: a. 22-year-old with persistent red-brown vaginal drainage 3
days after having balloon thermotherapy
b. 42-year-old with secondary amenorrhea who says that her last menstrual cycle was 3 months ago
c. 35-year-old with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month
ago
D. 19-year-old with menorrhagia who has been using superabsorbent tampons and has fever with
weakness Rational:
The patients history and clinical manifestations suggest possible toxic shock syn- drome, which will
require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and
do not indicate life-threatening complications.
2. A healthy 28-year-old who has been vaccinated against human papillo- mavirus (HPV) has a
normal Pap test. Which information will the nurse include in patient teaching when calling the
patient with the results of the Pap test?-
: Pap testing is recommended every 3 years for women your age.
3. To prevent pregnancy in a patient who has been sexually assaulted, the nurse in the
emergency department will plan to teach the patient about the use of: levonorgestrel (Plan-B
One-Step).
Rational:
Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of inter- course. The other
methods are used for therapeutic abortion, but not for pregnancy prevention after unprotected
intercourse.
4. A 22-year-old tells the nurse that she has not had a menstrual period for the last 2 months.
Which action is MOST important for the nurse to take?: A. Obtain a urine specimen for a
pregnancy test.
b. Ask about any recent stressful lifestyle changes.
c. Measure the patients current height and weight.
d. Question the patient about prescribed medications. Rational:
, Lewis Test Bank
Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age.
The other actions are also appropriate, but it is important to check for pregnancy in this patient because
pregnancy will require rapid implemen- tation of actions to promote normal fetal development such as
changes in lifestyle, folic acid intake, etc.
5. Which information will the nurse include when teaching a patient who has developed a
small vesicovaginal fistula 2 weeks into the postpartum period?: a. Take stool softeners to
prevent fecal contamination of the vagina.
b. Limit oral fluid intake to minimize the quantity of urinary drainage.
C. Change the perineal pad frequently to prevent perineal skin breakdown.
d. Call the health care provider immediately if urine drains from the vagina. Rational:
Because urine will leak from the bladder, the patient should plan to use perineal pads and change them
frequently. A high fluid intake is recommended to decrease the risk for urinary tract infections.
Drainage of urine from the vagina is expected with vesicovaginal fistulas. Fecal contamination is not a
concern with vesicovaginal fistulas.
6. The nurse has just received change-of-shift report about the following four patients. Which
patient should be assessed FIRST?: a. A patient with a cervical radium implant in place who is crying
in her room
b. A patient who is complaining of 5/10 pain after an abdominal hysterectomy
C. A patient with a possible ectopic pregnancy who is complaining of shoulder pain
d. A patient in the fifteenth week of gestation who has uterine cramping and spotting Rational:
The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate
assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be
assessed as quickly as possible but do not have symptoms of life-threatening complications
7. A 27-year-old patient tells the nurse that she would like a prescription for oral contraceptives
to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information
is MOST important to communicate to the health care provider?: a. Bilateral breast tenderness
b. Frequent abdominal bloating
C. History of migraine headaches
d. Previous spontaneous abortion Rational:
, Lewis Test Bank
Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other
patient information would not prevent the patient from receiv- ing oral contraceptives.
8. The nurse notes that a patient who has a large cystocele, admitted 10 hours ago, has not yet
voided. Which action should the nurse take FIRST?: a. Insert a straight catheter per the PRN order.
b. Encourage the patient to increase oral fluids.
c. Notify the health care provider of the inability to void. D. Use an ultrasound scanner to check for
urinary retention.
Rational:
Because urinary retention is common with a large cystocele, the nurses first action should be to use an
ultrasound bladder scanner to check for the presence of urine
in the bladder. The other actions may be appropriate, depending on the findings with the bladder
scanner.
9. A 58-year-old patient who has undergone a radical vulvectomy for vulvar carcinoma returns
to the medical-surgical unit after the surgery. The PRIORITY nursing diagnosis for the patient at
this time is: A. risk for infection related to contact of the wound with urine and stool.
b. self-care deficit: bathing/hygiene related to pain and difficulty moving.
c. imbalanced nutrition: less than body requirements related to low-residue diet.
d. risk for ineffective sexual pattern related to disfiguration caused by the surgery. Rational:
Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The
other nursing diagnoses may also be appropriate for the patient but are not the highest priority
immediately after surgery.
10.A 32-year-old woman brought to the emergency department reports being sexually assaulted.
The patient is confused about where she is and she has a large laceration above the right eye.
Which action should the nurse take FIRST?: A. Assess the patients neurologic status.
b. Assist the patient to remove her clothing.
c. Contact the sexual assault nurse examiner (SANE).
d. Ask the patient to describe what occurred during the assault. Rational:
The first priority is to treat urgent medical problems associated with the sexual assault. The patients
