During a health history, a 22-year old woman asks, "Can I get that vaccine for HPV? I have genital warts and I'd like them to go away!" What is the nurse's best response?
A)
"The HPV vaccine is for girls and women ages 9 to 26, so we can start that today.
ANS: D
The HPV (human papillomavirus) vaccine is appropriate for girls and women age 9 to 26 and is given to prevent cervical cancer by preventing HPV infections before girls become sexually active. However, it cannot protect the woman if an HPV infection
During an examination the nurse observes a female patient's vestibule and expects to see the:
A)
urethral meatus and vaginal orifice.
B)
vaginal orifice and vestibular (Bartholin) glands.
C)
urethral meatus and paraurethral (Skene) glands.
D)
paraurethral
ANS: A
The labial structures encircle a boat-shaped space, or cleft, termed the vestibule. Within it are numerous openings. The urethral meatus and vaginal orifice are visible. The ducts of the paraurethral (Skene) glands and the vestibular (Bartholin) gl
During a speculum inspection of the vagina, the nurse would expect to see what at the end of the vaginal canal?
A)
Cervix
B)
Uterus
C)
Ovaries
D)
Fallopian tubes
ANS: A
At the end of the canal, the uterine cervix projects into the vagina
The uterus is usually positioned tilting forward and superior to the bladder. This position is known as:
A)
anteverted and anteflexed.
B)
retroverted and anteflexed.
C)
retroverted and retroflexed.
D)
superiorverted and anteflexed.
ANS: A
The uterus is freely movable, not fixed, and usually tilts forward and superior to the bladder (a position labeled as anteverted and anteflexed).
An 11-year-old girl is in the clinic for a sports physical. The nurse notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. The nurse should use which of these techniques to
ANS: A
Tanner's table on the five stages of pubic hair development is helpful in teaching girls the expected sequence of sexual development (see Table 26-1). The other responses are not appropriate.
A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart that her cervix is softened and looks cyanotic. The nurse knows that the woman is exhibiting _____ sign and _____ sign.
A)
Tanner's; Hegar's
B)
Hegar's; Goodell's
ANS: D
Shortly after the first missed menstrual period, the female genitalia show signs of the growing fetus. The cervix softens (Goodell's sign) at 4 to 6 weeks, and the vaginal mucosa and cervix look cyanotic (Chadwick's sign) at 8 to 12 weeks. These ch
A woman who is 22 weeks pregnant has a vaginal infection. She tells the nurse that she is afraid that this infection will hurt the fetus. The nurse knows that which of these statements is true?
A)
If intercourse is avoided, then the risk for infection is
ANS: B
A clot of thick, tenacious mucus forms in the spaces of the cervical canal (the mucus plug), which protects the fetus from infection. Cervical and vaginal secretions increase during pregnancy and are thick, white, and more acidic. The acidic pH kee
The changes normally associated with menopause occur generally because the cells in the reproductive tract are:
A)
aging.
B)
becoming fibrous.
C)
estrogen dependent.
D)
able to respond to estrogen.
ANS: C
Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes. The other options are not correct.
The nurse is reviewing the changes that occur with menopause. Which of these are changes associated with menopause?
A)
Uterine and ovarian atrophy along with thinning vaginal epithelium
B)
Ovarian atrophy, increased vaginal secretions, and increasing clit
ANS: A
The uterus shrinks because of its decreased myometrium. The ovaries atrophy to 1 to 2 cm and are not palpable after menopause. The sacral ligaments relax, and the pelvic musculature weakens, so the uterus droops. The cervix shrinks and looks paler
A 54-year-old woman who has just completed menopause is in the clinic today for a yearly physical examination. Which of these statements should the nurse include in patient education? "A postmenopausal woman:
A)
is not at any greater risk for heart diseas
ANS: B
Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse (dyspareunia). The other statements are incorrect.
A woman is in the clinic for an annual gynecologic examination. The nurse should plan to begin the interview with the:
A)
menstrual history because it is generally nonthreatening.
B)
obstetric history because it is the most important information.
C)
urina
ANS: A
Menstrual history is usually nonthreatening; thus it is a good place to start. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start.
A patient has had three pregnancies and two live births. The nurse would record this information as gravida _____, para _____, AB _____.
A)
2; 2; 1
B)
3; 2; 0
C)
3; 2; 1
D)
3; 3; 1
ANS: C
Gravida is number of pregnancies. Para is number of births. Abortions are interrupted pregnancies, including elective abortions and spontaneous miscarriages.
During the interview with a female patient, the nurse gathers data that indicate that the patient is perimenopausal. Which of these statements made by this patient leads to this conclusion?
A)
"I have noticed that my muscles ache at night when I go to bed
ANS: C
Hormone shifts occur during the perimenopausal period, and associated symptoms of menopause may occur, such as hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, and itching. Th
A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts and wonders if they could be due to the hormone replacement therapy (HRT) she started 3 months ago. The nurse should tell her:
A)
"Hormone replacement therap
ANS: B
Side effects of hormone replacement therapy include fluid retention, breast pain, and vaginal bleeding. The other responses are not correct.
A 52-year-old patient states that when she sneezes or coughs she "wets herself a little." She is very concerned that something may be wrong with her. The nurse suspects that the problem is:
A)
dysuria.
B)
stress incontinence.
C)
hematuria.
D)
urge inconti
ANS: B
Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing. Dysuria is pain or burning with urination. Hematuria is bleeding with urination. Urge incontinence is involuntary urine loss but it occurs due to an overacti
During the interview a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse's most appropriate response to this would be:
A)
"Oh, don't worry. Some cyclic vaginal discharge is norma
ANS: C
Ask questions that help the patient reveal more information about her symptoms in a nonthreatening manner. Assess vaginal discharge further by asking about the amount, color, and odor. Normal vaginal discharge is small, clear or cloudy, and always
A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse should ask, "Have you noticed:
A)
a change in your urination patterns?"
B)
any excessive vaginal bleeding?"
C)
any
ANS: C
Several medications may increase the risk of vaginitis. Broad-spectrum antibiotics alter the balance of normal flora, which may lead to the development of vaginitis. The other questions are not correct
Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview?
A)
"Now it is time to talk about your sexual history. When did you first have intercourse?"
B)
"Women often feel dissatisfied wi
ANS: C
The nurse should begin with an open-ended question to assess individual needs. The nurse should include appropriate questions as a routine part of the history, because doing so communicates that the nurse accepts the individual's sexual activity an
A 22-year-old woman has been considering using oral contraceptives. As a part of her history, the nurse should ask:
A)
"Do you have a history of heart murmurs?"
B)
"Will you be in a monogamous relationship?"
C)
"Have you thought this choice through carefu
ANS: D
Oral contraceptives, together with cigarette smoking, increase the risk for cardiovascular side effects. If cigarettes are used, then the nurse should assess smoking history. The other questions are not appropriate.
A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first?
A)
Ascertain whether either of them has been using broad-spectrum antibiotics
ANS: B
Infertility is considered after 1 year of engaging in unprotected sexual intercourse without conceiving. The other actions are not appropriate
A nurse is assessing a patient's risk of contracting a sexually transmitted infection (STI). An appropriate question to ask would be:
A)
"You know that it's important to use condoms for protection, right?"
B)
"Do you use a condom with each episode of sexu
ANS: B
In reviewing a patient's risk for sexually transmitted infections, the nurse should ask, in a nonconfrontational manner, whether condoms are used at each episode of sexual intercourse. Asking a person whether he or she has an infection does not add
When the nurse is interviewing a preadolescent girl, which opening statement would be least threatening?
A)
"Do you have any questions about growing up?"
B)
"What has your mother told you about growing up?"
C)
"When did you notice that your body was chang
ANS: C
Try the open-ended, "When did you ... ?" rather than "Do you ... ?" This is less threatening because it implies that the topic is normal and unexceptional.
When the nurse is discussing sexuality and sexual issues with adolescents, a permission statement helps to convey that it is normal to think or feel a certain way. Which of these is the best example of a permission statement?
A)
"It is okay that you have
ANS: B
Start with a permission statement, "Often girls your age experience . . . ." This conveys that it is normal to think or feel a certain way, and it is important to relay that the topic is normal and unexceptional.
The nurse is preparing to interview a postmenopausal woman. Which of these statements is true with regard to the history of a postmenopausal woman?
A)
The nurse should ask a postmenopausal woman if she ever has vaginal bleeding.
B)
Once a woman reaches me
ANS: A
Postmenopausal bleeding warrants further workup and referral. The other statements are not true.
During the examination portion of a patient's visit, she will be in lithotomy position. Which statement below reflects some things that the nurse can do to make this more comfortable for her?
A)
Ask her to place her hands and arms behind her head.
B)
Elev
ANS: B
The nurse should elevate her head and shoulders to maintain eye contact. The patient's arms should be placed at her sides or across the chest, not behind the head, because this position only tightens the abdominal muscles. The feet should be placed
An 18-year-old patient is having her first pelvic examination. Which action by the nurse is appropriate?
A)
Invite her mother to be present during the examination.
B)
Avoid the lithotomy position this first time because it can be uncomfortable and embarra
ANS: C
Use the techniques of the educational or mirror pelvic examination. This is a routine examination with some modifications in attitude, position, and communication. First, the woman is considered an active participant, one who is interested in learn
The nurse has just completed an inspection of a nulliparous woman's external genitalia. Which of these would be a description of a finding within normal limits?
A)
Redness of the labia majora
B)
Multiple nontender sebaceous cysts
C)
Discharge that is stic
ANS: B
There should be no lesions, except for occasional sebaceous cysts. These are yellowish 1-cm nodules that are firm, nontender, and often multiple. The labia majora are dark pink, moist, and symmetrical; redness indicates inflammation or lesions. Dis
The nurse is preparing for an internal genitalia examination of a woman. Which order of the examination is correct?
A)
Bimanual, speculum, rectovaginal
B)
Speculum, rectovaginal, bimanual
C)
Speculum, bimanual, rectovaginal
D)
Rectovaginal, bimanual, spec
ANS: C
The correct sequence is speculum examination, then bimanual examination after removing the speculum, and then rectovaginal examination. The examiner should change gloves before performing the rectovaginal examination to avoid spreading any possible
During an internal examination of a woman's genitalia, the nurse will use which technique for proper insertion of the speculum?
A)
Instruct the woman to bear down, open the speculum blades, and apply in a swift, upward movement.
B)
Insert the blades of th
ANS: C
The examiner should instruct the woman to bear down, turn the width of the blades horizontally, and insert the speculum at a 45-degree angle downward toward the small of the woman's back. See the text under "Speculum Examination" for more detail.
The nurse is examining a 35-year-old female patient. During the history, the nurse notices that she has had two term pregnancies, and both babies were delivered vaginally. During the internal examination the nurse observes that the cervical os is a horizo
ANS: C
Normal findings: Nabothian cysts may be present on the cervix after childbirth. The cervical os is a horizontal, irregular slit in the parous woman. Secretions vary according to the day of the menstrual cycle, and may be clear and thin or thick, op
A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are:
A)
"If you are menstruating, please use pads to avoid placing anything into the vagina."
B)
"Avoid intercourse, ins
ANS: B
When instructing a patient before a Papanicolaou (Pap) smear is obtained, the nurse should follow these guidelines: Do not obtain during the woman's menses or if a heavy infectious discharge is present. Instruct the woman not to douche, have interc
During an examination, which tests will the nurse collect to screen for cervical cancer?
A)
Endocervical specimen, cervical scrape, and vaginal pool
B)
Endocervical specimen, vaginal pool, and acetic acid wash
C)
Endocervical specimen, KOH preparation, an
ANS: A
Laboratories may vary in method, but usually the test consists of three specimens: endocervical specimen, cervical scrape, and vaginal pool. The other tests (acetic acid wash, KOH preparation, and saline mount) are used to test for sexually transmi
When performing the bimanual examination, the nurse notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. The nurse's interpretation of the
ANS: C
Normally the cervix feels smooth and firm, as the consistency of the tip of the nose. It softens and feels velvety at 5 to 6 weeks of pregnancy (Goodell's sign). The cervix should be evenly rounded. With a finger on either side, the examiner should
The nurse is palpating a female patient's adnexa. The findings include a firm, smooth uterine wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and pulsating. The nurse's most appropriate course of action would be to:
A)
ANS: B
Normally the uterine wall feels firm and smooth, with the contour of the fundus rounded. Ovaries are not often palpable, but when they are, they normally feel smooth, firm, and almond shaped and are highly movable, sliding through the fingers. The
A 65-year-old woman is in the office for routine gynecologic care. She had a complete hysterectomy 3 months ago after cervical cancer was detected. The nurse knows that which of these statements is true with regard to this visit?
A)
Her cervical mucosa wi
ANS: D
In the aging adult woman, natural lubrication is decreased; to avoid a painful examination, the nurse should take care to lubricate instruments and the examining hand adequately. Menopause, with the resulting decrease in estrogen production, shows
The nurse is preparing to examine the external genitalia of a school-age girl. Which of these positions would be most appropriate in this situation?
A)
In the parent's lap
B)
In a frog-leg position on the examining table
C)
In the lithotomy position with
ANS: B
For school-age children it is best to place them on the examining table in a frog-leg position. With toddlers and preschoolers, it is best to have the child on the parent's lap in a frog-leg position.
When assessing a newborn infant's genitalia, the nurse notices that the genitalia are somewhat engorged. The labia majora are swollen, the clitoris looks large, and the hymen is thick. The vaginal opening is difficult to visualize. The infant's mother sta
ANS: A
It is normal for a newborn's genitalia to be somewhat engorged. A sanguineous vaginal discharge or leukorrhea is normal during the first few weeks because of the maternal estrogen effect. During the early weeks, the genital engorgement resolves, an
During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white dischar
ANS: A
The woman with candidiasis often reports intense pruritus and thick white discharge. The vulva and vagina are erythematous and edematous. The discharge is usually thick, white, and curdlike. Infection with trichomoniasis causes a profuse, watery, g
A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the nurse notices clusters of small, shallow vesicles with surrounding erythema on the labia. There is also inguinal lymphadenopath
ANS: D
Herpes simplex virus type 2 presents with clusters of small, shallow vesicles with surrounding erythema that erupt on the genital areas. There is also the presence of inguinal lymphadenopathy. The individual reports local pain, dysuria, and fever.
When performing an external genitalia examination of a 10-year-old girl, the nurse notices that there is no pubic hair, and the mons and the labia are covered with fine vellus hair. These findings are consistent with stage _____ of sexual maturity, accord
ANS: A
Sexual Maturity Rating stage 1 is the preadolescent stage. There is no pubic hair. The mons and labia are covered with fine, vellus hair as on the abdomen. See Table 26-1.
A 46-year-old woman is in the clinic for her annual gynecologic examination. She voices a concern about ovarian cancer because her mother and sister died of it. The nurse knows that which of these statements is correct regarding ovarian cancer?
A)
Ovarian
ANS: C
With ovarian cancer, the patient may have abdominal pain, pelvic pain, increased abdominal size, bloating, and nonspecific gastrointestinal symptoms, or she may be asymptomatic. The Pap smear does not detect the presence of ovarian cancer. Annual t
During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy and fixed, with a poorly defined mass. This finding is suggestive of:
A)
an ovarian cyst.
B)
endometriosis.
C)
ovarian cancer.
D)
an ectopic pregnancy.
ANS: C
Ovarian tumors that are solid, heavy, and fixed, with poorly defined mass are suggestive of malignancy. Benign masses may feel mobile and solid. An ovarian cyst may feel smooth, round, fluctuant, mobile, and nontender. With an ectopic pregnancy, th
A 25-year-old woman comes to the emergency department with a sudden fever of 101� F and abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, t
ANS: D
These signs and symptoms are suggestive of acute pelvic inflammatory disease, also known as acute salpingitis. See Table 26-7. For description of endometriosis and uterine fibroids, see Table 26-6; for description of ectopic pregnancy, see Table 26
During an external genitalia examination of a woman, the nurse notices several lesions around the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is not aware of any problems in that area. The nurse recognizes th
ANS: C
HPV lesions are painless, warty growths that the woman may not notice. Lesions are pink or flesh colored, soft, pointed, moist, warty papules that occur in single or multiple cauliflower-like patches around the vulva, introitus, anus, vagina, or ce
During an examination, the nurse would expect the cervical os of a woman who has never had children to appear:
A)
stellate.
B)
small and round.
C)
as a horizontal irregular slit.
D)
everted.
ANS: B
The cervical os in a nulliparous woman is small and round. In the parous woman, it is a horizontal, irregular slit that also may show healed lacerations on the sides. See Figure 26-13.
A woman has just been diagnosed with HPV, or genital warts. The nurse should counsel her to receive regular examinations because this virus makes her at a higher risk for _____ cancer.
A)
uterine
B)
cervical
C)
ovarian
D)
endometrial
ANS: B
HPV is the virus responsible for most cases of cervical cancer, not the other options.
During an internal examination, the nurse notices that the cervix bulges outside the introitus when the patient is asked to strain. The nurse will document this as:
A)
uterine prolapse, graded first degree.
B)
uterine prolapse, graded second degree.
C)
ut
ANS: B
The cervix should not be found to bulge into the vagina. Uterine prolapse is graded as follows: first degree�cervix appears at introitus with straining; second degree�cervix bulges outside introitus with straining; and third degree�whole uterus pro
A 35-year-old woman is at the clinic for a gynecologic examination. During the examination, she asks the nurse, "How often do I need to have this Pap test done?" Which reply by the nurse is correct?
A)
"It depends. Do you smoke?"
B)
"This will need to be
ANS: D
Cervical cancer screening with the Pap test continues annually until age 30. After age 30, if the woman has 3 consecutive normal Pap tests, then women may be screened every 2 to 3 years.
The nurse is palpating an ovarian mass during an internal examination of a 63-year-old woman. Which findings of the mass's characteristics would suggest the presence of an ovarian cyst? Select all that apply.
A)
Heavy and solid
B)
Mobile and fluctuant
C)
ANS: B, E
An ovarian cyst (fluctuant ovarian mass) is usually asymptomatic, and would feel like a smooth, round, fluctuant, mobile, nontender mass on the ovary. A mass that is heavy, solid, fixed, and poorly defined suggests malignancy. A benign mass may