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139 Cards in this Set

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A 20 year old woman tells the nurse that she performs BSE on a regular basis. The nurse evaluates the woman's understanding of BSE and ability to perform the technique correctly. Which of the following actions by the woman indicate that she needs further instructions regarding BSE?

Performs BSE every month on the first day of her menstrual cycle and Uses the tips of her four fingers to palpate her breast
A nurse instructed a female patient regarding vulvar self exam. Which of the following statements made by the patient will require further instruction?
I will use the exam to determine when I should get medication at the pharmacy for infections
A woman's health nurse practitioner is going to perform a pelvic exam on a female patient. Which of the following nursing actions would be least effective in enhancing the patient's comfort and relaxation during the exam?
Ask the patient questions as the exam is performed
To enhance the accuracy of the pap test, the nurse should instruct the patient to do which of the following?
Avoid intercourse for 24 hours before the test.
When assessing women, it is important for the nurse to keep in the mind the possiblity that they are victims of violence. The nurse should:
Use an abuse assessment screen during the assessment of every woman.
Which of the following woman is at greatest risk for developing hypogonadotropic amenorrhea?
13 year old figure skater
Pharmacologic preparations can be used to treat primary dysmenorrhea. Which preparation would be least effective in relieving the symptoms of primary dysmenorrhea?
Acetaminophen (Tylenol)
Women experiencing PMS should be advised to avoid use of the following?
The nurse counseling a 30 year old woman regarding effective measures to use to relieve the discomfort associated with dysmenorrhea could suggest which of the following?
Use back massages and heat application to abdomen to enhance relaxation and circulation, add vegetables such as asparagus to the diet, perform effleurage and guided imagery for relaxation and distraction
A 28 year old woman has been diagnosed with endometriosis. She has been placed on a course of treatment with danazol (danocrine). The woman exhibits understanding of this treatment when she says which of the following?
I should follow a low fat diet since this medication can increase the level of cholesterol in my blood, I can experience a decrease in my breast size, oily skin, and hair growth on my face as a result of taking this medication, I may need to use lubricant during intercourse to reduce discomfort.
A 55 year old woman tells the nurse that she has started to experience pain when she and her husband have intercourse. The nurse would record that this woman is experiencing:
Infections of the female midreproductive tract, such as chlamydia, are dangerous primarily because these infections:
Are asymptomatic.
A finding associated with HPV infection would include which of the following?
Soft papillary swelling occuring singly or in clusters
A recommended medication effective in the treatment of vulvovaginal candidiases would be which of the following?
Miconazole (monistat)
A woman is determined to be GBS positive at the onset of her labor. The nurse should prepare this woman for which of the following?
IV administration of an abx during labor.
When providing a woman recovering from primary herpes with information regarding the recurrent of herpes infection of the genital tract, the nurse would tell her which of the following?
Itching and tingling often occur before the appearance of vesicles
When teaching women about breast cancer, the nurse should emphasize which of the following facts?
The mortality rate from breast cancer has been declining since 1990, lowering fat intake and maintaining a normal weight could have an effect on reducing a woman's chances of developing breast cancer, the majority of breast lumps found by woman are not malignant.
When providing discharge instructions to a woman who had a modified right radical masectomy, the nurse should emphasize the important of which of the following?
Telling health care providers not to take a blood pressure or draw blood from her right arm.
A 26 year old woman has just been dx'd with fibro cystic change in her breasts. Which of the following nursing dx would be a priority for this woman?
Acute pain r/t cyclical enlargement of breast cysts or lumps
When assessing a woman with a dx of fibroadenoma, the nurse would expect to find which of the following characteristics?
Well-delineated, firm moveable lump in the upper outer quadrant of one breast.
A 40 year old woman at risk for breast cancer has elected chemoprevention as an approach to reduce her risk. She will be receiving tamoxifen. The nurse will recognize that this woman understood instructions given to her regarding this medication if she makes which of the following statement?
I can take this medication on an empty stomach or with food.
Herbal preparations can be used as part of the treatment for a variety of menstrual disorders. Which of the following herbs would be beneficial for a woman experiencing menorrhagia?
Shepherd's purse
A 34 year old woman at 36 weeks of gestation has been scheduled for a biophysical profile. She asks the nurse why the test needs to be performed. The nurse would tell her that the test:
Observes her baby's activities in utero to ensure that her baby is getting enough oxygen.
As part of preparing a 24 year old woman at 42 weeks of gestation for a nonstress test, the nurse would:
Show her how to indicate when her baby moves.
A 40 year old woman at 18 weeks gestation is having a triple marker test performed. She is obese, and her health hx reveals that she is rh negative. The primary purpose of this test is to screen for:
Down syndrome
During a contraction stress test, 4 contractions lasting 45-55 seconds were recorded in a 10 minute period. A late deceleration was noted during the third contraction. The nurse conducting the test would document that the result is:
A pregnant woman is scheduled for a transvaginal ultrasound test to establish gestational age. In preparing this woman for the test, the nurse would:
Place the woman in a supine position with her hips elevated on a folded pillow.
In the US, the three leading causes of maternal mortality are which of the following?
Gestational HTN, pulmonary embolism, hemorrhage
An obese pregnant woman with gestational diabetes is learning self injection of insulin. While evaluating the woman's technique for self injection, the nurse would recognize that the woman understood the instructions when she:
Spread her skin taut and punctured the skin at a 90 degree angle.
When assessing a pregnant woman at 28 weeks of gestation who is dx'd with mitral valve stenosis, the nurse must be alert for signs indicating cardiac decompensation. Signs of cardiac decompensation would include which of the following?
Increasing fatigue, progressive edema, orthopnea with increasing dyspnea
A woman at 30 weeks of gestation with a class II cardiac d/o calls her primary health care provider and speaks to the nurse practitioner. She tells the nurse that she has been experiencing a frequent moist cough for the past few days. In addition, she has been feeling more tired and is having difficulty completing her routine activities as a result of some difficulty with breathing. THe nurse's best response would be:
Have someone bring you to the office so we can assess your cardiac status.
When measuring the BP to ensure consistency and to facilitate early detection of BP changes consistent with gestational hypertension, the nurse should:
Use the same arm for each BP measurement.
When caring for a woman with mild preeclampsia, it is critical that during assessment the nurse is alert for signs of progress to severe preeclampsia. Progress to severe preeclampsia would be indicated by which one of the following assessment findings?
Proteinuria of 2+ or greater
A woman's preeclampsia has advanced to the severe stage. She is admitted to the hospital and her primary health care provider has ordered an infusion of mag sulfate be started. In fulfilling this order the nurse would implement which of the following?
Prepare the maintenance solution by mixing 40 g of mag sulfate in 1000 ml of LR solution, Expect the maintenance dose to be approx 1-3g/hour, report a RR of 12 breaths or less per minute to the primary HCP immediately, recognize that urinary output should be at least 30 ml/hr.
The primary expected outcome for care associated with the administration of mag sulfate would be met if the woman exhibits which of the following?
Experiences no seizures
A woman has been diagnosed with mild preeclampsia and will be treated at home. The nurse, in teaching this woman about her treatment regimen for mild preeclampsia would tell her to do which of the following?
Place a dipstick into a clean catch sample of her urine to test for protein, do gentle exercises such as hand and feet exercises and gently tensing and relaxing arm and leg muscles, avoid excessively salty foods.
A woman has just been admitted with a diagnosis of hyperemesis gravidarum. She has been unable to retain any oral intake and as a result has lost weight and is exhibiting signs of dehydration with electrolyte imbalance and acetonuria. The care management of this woman would include which of the following?
Administering promethazine (Phenergan) to control N/V.
A primagravida at 10 weeks of gestation reports slight vaginal spotting without passage of tissue and mild uterine cramping. When examined, no cervical dilation is noted. The nurse caring for this woman would:
Anticipate that the woman will be sent home and placed on bed rest with instructions to avoid stress and orgasm.
A woman is admitted through the ER with a medical dx of ruptured ectopic pregnancy. The primary nursing dx at this time would be:
Deficient fluid volume related to blood loss associated with rupture of the uterine tube.
A woman dx'd with an ectopic pregnancy is given an intramuscular injection of methotrexate. The nurse would tell the woman which of the following?
She should avoid alcohol until her primary care provider tells her the treatment is complete.
A pregnant woman at 32 weeks of gestation comes to the emergency room because she has begun to experience bright red vaginal bleeding. She reports that she is experiencing no pain. THe admission nurse suspects:
Placenta previa
A pregnant woman, at 38 weeks of gestation dx'd with marginal placenta previa, has just given birth to a healthy newborn male. The nurse recognizes that the immediate focus for the care of this woman would be:
Preventing hemorrhage
When assessing a pregnant woman, the nurse is alert for factors associated with preterm labor. Which of the following factors, if exhibited by this woman, would increase her risk for preterm labor and birth?
Obstetric history: 3-0-2-0-1, works as a second grade teacher, currently being treated for second bladder infection in 4 months.
Bed rest for prevention of preterm birth can result in which of the following effects:
Bone demineralization with calcium loss, fatigue, dysphoria and guilt, emotional lability
A woman's labor is being suppressed using IV mag sulfate. Which of the following measures should be implemented during the infusion?
Limit fluid intake to 1500-2500 ml per day.
The physician has ordered that dinoprostone(Cervadil) be administered to ripen a pregnant woman's cervix in preparation for an induction of her labor. In fulfilling this order, the nurse would do which of the following?
Observe the woman for signs of tachysystole
A nulliparous woman experiencing a postterm pregnancy is admitted for labor induction. Assessment reveals a bishop score of 9. THe nurse would:
Begin the infusion at a rate b/t 0.5-2 milliunits/min as determined by the induction protocol.
A woman's labor is being induced. THe nurse assesses the woman's status and that of her fetus and the labor process just before an infusion increment of 2 mu/min. The nurse would discontinue the infusion and notify the woman's primary HCP if which of the following had been noted during the assessment?
Frequency of uterine contractions: every 1.5 minutes
A laboring woman's vaginal examination reveals the following: 3 cm, 50%, LSA, 0. The nurse caring for this woman would:
Expect the progress of fetal descent to be slower than usual.
A nurse is caring for a pregnant woman at 30 weeks of gestation in preterm labor. The woman's physician orders Betamethasone 12 mg IM for 2 doses with the first does to begin at 11am. In implementing this order, the nurse would do which of the following?
Assess the woman for signs of pulmonary edema.
A nurse caring for a pregnant woman suspected of being in preterm labor would recognize which of the following as diagnostic of preterm labor?
Cervical dilation of at least 2 cm.
Prior to d/c at 2 days postpartum, the nurse evaluates a woman's level of knowledge regarding the care of her episiotomy. Which of the following statements if made by the woman would indicate the need for further instruction before she goes home?
I will continue to apply ice packs to my perineum to reduce swelling, I will take a sitz bath once a day before bed for about 10 minutes, I will apply the anesthetic cream to my stitches for at least 6 times a day.
When assessing postpartum woman during the first 24 hours after birth, the nurse must be alert for signs that could indicate the development of pp physiologic complications. Which of the following signs would be of concern to the nurse?
Fundus - midline, boggy, positive homan sign in right leg, anorexia
Methergine 0.2 mg is ordered to be administered IM to a woman who gave birth vaginally 1 hour ago for a profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with IV mag sulfate at 1g/hr. Her BP, measured 5 mins ago, was 155/98. In fulfilling this order, the nurse would do which of the following?
Question the order based on the woman's hypertensive status.
A postpartum woman in the 4th stage of labor received prostaglandin (Hemabate) 0.25 mg IM. The expected outcome of care for the admin of this medication would be which of the following?
Limitation of excessive blood loss that is occurring after birth.
The nurse responsible for the care of pp woman should recognize that the first sign of puerperal infection would most likely be which of the following?
Fever with body temp at 38 C or higher after the first 24 hours following birth.
A breastfeeding woman's c-section birth occurred 2 days ago. Investigation of the pain, tenderness and swelling in her left leg led to a medical dx of DVT. Care mgmt for this woman during the acute stage of the DVT would involve which of the following actions?
Administering heparin via continuous IV drip, placing the woman on bed rest with her left leg elevated, encouraging the woman to change her position frequently when on bed rest, telling the woman to use acetaminophen for discomfort.
Which of the following would be a priority question to ask a woman experiencing pp depression?
Have you thought about hurting yourself?
A woman gave birth to twin girls, one of whom was stillborn. WHich of the following nursing actions would be least helpful in supporting the woman as she copes with her loss?
Remind her that she should be happy that one daughter survived and is healthy.
During the acute distress phase of the grief response parents are most likely to experience which of the following?
Sadness and depression, denial and disbelief.
A 17 year old woman experiences a miscarriage at 12 weeks gestation. When she is informed about the miscarriage she begins to cry, stating that she was upset about her pregnancy at first and now she is being punished for not wanting the baby. Which of the following would be the nurse's best response?
This must be so hard for you. I am here if you want to talk.
Preterm infants are at increased risk for developing respiratory distress. The nurse should assess for signs that would indicate that the newborn is having difficulty breathing. Which of the following is a sign of respiratory distress?
Tachypnea, suprasternal retraction, nasal flaring
When caring for a preterm infant born at 30 weeks gestation, the nurse should recognize which of the following as the newborn's primary nursing dx?
Ineffective breathing pattern r/t surfactant deficiency and weak respiratory muscle effort.
A nurse is preparing to insert a gavage tube and feed a preterm newborn. As part of the protocol for this procedure, the nurse would do which of the following?
Determine the length of tubing to be inserted by measuring from tip of nose to lobe of ear to midpoint b/t xiphoid process and umbilicus, coat the tube with sterile water to ease passage, allow the feeding to flow by gravity at a rate of 1 ml/min, hold the swaddled infant during the feeding to help him/her associate feeding with positive interactions.
The nurse is caring for a newborn whose mother had gestational diabetes. His estimated gestational age is 41 weeks, and his weight indicates that he is macrosomic. When assessing this newborn, the nurse should be alert for which of the following?
Blood glucose level less than 40 mg/dl.
When assessing a newborn after birth, the nurse notes that his left arm hangs limp alongside his body, his shoulder and arm are adducted and internally rotated, and his elbow is extended with forearm pronated and wrists and fingers flexed. His grasp reflex is strong bilaterally. The nurse suspects which of the following as the basis for these assessment finding?
Fracture of the clavicle
The nurse is teaching a women's health education class advising participants about the pelvic exam procedure. Which point does the nurse make about pelvic exams?
The pelvic exam can be used to assess for infection or menstrual irregularities.
The adult patient is scheduled to have an endometrial biopsy. What does the nurse teach this patient about the test?
Sex activity should be postponed until the vaginal d/c stops.
The nurse is taking a hx from the female patient whose mother was given DES during pregnancy. What must the nurse advise this patient about?
Need for regular gyn exams because of the increased risk for reproductive tract cancer.
The 40 year old woman has heavy vaginal bleeding. Which question is the priority in evaluating the patient's chief complaint?
Are you feeling weak, dizzy, or lightheaded?
The young woman reports that she has a genital d/c causing irritation and odor. SHe feels embarrassed, but insists that she has not had recent sexual relations. What does the nurse assess for?
Current use of abx meds, type of clothing and undergarments, presence of genital or orifice lesions, chronic presence of the d/c.
Which phrase describes a rectocele?
Bulge in the posterior vaginal wall
The nurse is giving d/c instructions to the patient who had a breast biopsy and aspiration. What does the nurse include in the d/c instructions?
Inform that discomfort is usually mild and is controlled with analgesics or the use of ice or heat, advise to check the area or incision for bleeding and edema, include instructions for BSE.
Which patient group is mostly likely to present with fibroadenoma as a common breast problem?
Women in their reproductive years
A pregnant woman discovers an oval shaped, freely mobile, rubbery mass in her breast. The physician recommends diagnostic testing for probable fibroadenoma. The nurse anticipates and prepares patient infor for which dx test?
Breast u/s exam
The nurse notes in the documentation that the patient has a round, firm, nontender, mobile breast mass not attached to breast tissue or the chest wall. What does this describe?
According to the latest studies, which woman has the greatest risk of developing breast ca?
Physician, age 56, who had her first child at age 38
The nurse is counseling the woman recently diagnosed with breast ca. Which factor has the most influence on the patient's choice for treatment?
Extent and location of metastasis of the breast mass.
The young patient is suspected of having invasive breast ca. Based on the types and frequencies of breast ca, what is the patient most likely to be diagnosed with?
Infiltrating ductal carcinoma
Cancer surveillance is used to detect cancer in it's early stages and is referred to as what kind of prevention?
How is the 3 pronged approach to early detection of breast cancer defined as?
Mammogram, BSE and CBE.
Which factor makes the mammogram a more sensitive screening tool than other tests?
Able to reveal masses too small to be palpated manually.
During a CBE, the examiner observes a discharge from the nipple. What is the most important to include in the documentation of this finding?
Area of "the clock" that was compressed when the d/c was released
Upon performing a CBE, which patient has a sx that suggests advanced disease?
Patient with a skin change of peau d'orange
The patient had a partial masectomy yesterday and the nurse writes on the nursing care plan, "Anxiety r/t removal of breast tissue." What is the nurse's priority intervention?
Encourage the patient to discuss her fears and ask questions about her concerns.
The patient had a partial masectomy. When teaching about the care of the arm on the affected side, what does the nurse tell the patient?
Keep the arm elevated so the elbow is above the shoulder and the wrist is above the elbow
The patient has recently been diagnosed with breast ca. What is the most likely priority preop nursing dx for this patient?
Which intervention is priority in the nursing care plan for the patient after a modified radical masectomy?
Teach the patient s/s of infection and how to monitor for altered wound healing.
The nurse is counseling the woman who has had several discussion with the HCP about her risk for breast ca. THe nurse reinforces that prophylactic masectomy would have what effect on her risk for developing breast ca?
Decreases the risk.
Which woman has the highest risk for developing breast ca?
68 year old who has taken HRT
Which physiologic factor is thought to be the etiologic cause of dysmenorrhea?
Increased production of prostaglandins
The obese 54 year old patient describes menstrual bleeding that occurs approx every 10 days. The nurse prepares the patient for which diagnostic test that is used to evaluate for endometrial cancer?
Endometrial biopsy
The patient who is very upset asks the nurse, "My doctor says I have endometriosis. That sounds so horrible. What does it mean?" What is the nurse's best response?
A special type of tissue, called endometrial tissue, is outside of your uterus.
What is the primary tx for dysfunctional uterine bleeding in perimenopausal woman?
What is the major reason for the onset of menopause and resulting atrophy of the vulvar organs?
Decrease in levels of estrogen
Which is a common cause of vaginitis?
Taking abx
The nurse is advising the patient about self care for vulvitis, which is caused by a nonpathologic condition. What information does the nurse provide?
Take a sitz bath for 30 mins several times a day, apply prescribed topical drugs such as hydrocortisone, remove any irritants or allergens, apply wet compresses
The patient with a high fever, headache, flu like sx and fainting is admitted with the dx of TSS. What additional clinical manifestations does the nurse assess for?
Sunburn-like rash with peeling of palms
The nurse is teaching a group of woman about preventing TSS. What information does the nurse provide to the group?
Use sanitary napkins at night, do not use a vaginal sponge for more than 30 hr at a time, if you use a diaphragm, remove it within 24 hr after intercourse, do not use a diaphragm during your menstrual period
The patient is admitted with TSS. What organism is frequently associated with this syndrome when it occurs as a menstrually related infection?
Staphylococcus aureus
The patient is recovering from repair of a cystocele. What post procedure intervention does the nurse teach the patient?
Perform perineal floor exercises
The patient is dx'd with uterine leiomyomas. What does the nurse expect to see in the documentation for this patient as the chief presenting complaint?
Abnormal vaginal bleeding
THe patient with uterine leiomyomas reports a feeling of pelvic pressure, constipation, urinary frequency, and says, "I can't button my pants anymore." What does the nurse assess for to further evaluate the patient's sx?
Abdominal distention or enlargement
Diagnostics for leiomyomas besides pelvic exam is?
Transvaginal u/s
Most common and priority nursing dx for leiomyomas is:
Risk for altered tissue perfusion
Patient undergone uterine artery embolization for tx of uterine leiomyomas. What to include in d/c teaching?
A flu like illness may develop
Total abdominal hysterectomy wants to resume activities because of young children at home. What post op infor does nurse provide to patient?
Avoid sitting for prolonged periods, do not lift anything heavier than 5 lbs, do not drive for at least 4 weeks or until surgeon approves.
D/C teaching for woman who had total hysterectomy is:
Wound care includes showering but not tub baths
Patient reporting swelling in the perineal area is dx'd with Bartholin cyst. Non surgical mgmt is recommended. What does the nurse instruct the patient to do?
Apply moist heat (sitz baths or hot wet packs) to the vulva
Older patient treated for endometrial cancer. Which common sx does nurse expect to find in the patient's record that was reported before the patient was dx'd?
Dysfunctional uterine bleeding
Which classi sx is indicative of invasive gyn cancer in the older patient?
Painless vaginal bleeding
Nurse taking hx on the patient with probably gyn cancer. Which clinical manifestation is a sign of metastasis?
Dysuria and hematuria
Discharge instructions for patient about having LEEP for tx and dx of cervical cancer?
Patient should expect spotting after procedure
Patient undergone a skinning vulvectomy for cancer of the vulva. What is the major focus of nursing care for this patient?
Wound healing and pain relief
Symptom is first sign of primary syphillis?
Small, painless, indurated, smooth weeping lesion
Patient calls nurse suspecting a one time exposure to syphillis that occurred 4 weeks ago. Pt reports being asymptomatic and abstinent since incident. What nurse best response?
The chancre can appear anywhere and then disappear, so you must come in for testing.
Pt tested for T pallidum and first slide is negative. THe patients HCP is relatively inexperienced. What is the nurse's primary concern?
The pt must be directed to return in 3 days for a repeat test
Primary syphillis prepares to admin and educate patient about which tx regiment?
Penicillin G given IM as a single 2.4 mil unit dose, and f/u eval at 6, 12, and 24 months
Jarisch-Herxheimer reaction is treated how?
Analgesics and antipyretics
Late tertiary syphillis patient. In addition to CNS involvement what findings does nurse see in chart?
Benign lesions of the skin, mucous membranes and bone
Medication prescribed for patient with early latent syphillis?
Screening test for syphillis?
VDRL serum
Nurse teaching patient being d/c'd after tx for genital herpes. Which patient statement indicates a need for further teaching?
After taking all my acyclovir, I will not have genital herpes anymore.
Why do women develop complications more than men when being treated for gonorrhea?
The disease is asymptomatic in the early stages
How long is incubation period for gonorrhea?
3-10 days
Which symptom is the most common in the male with chlamydia?
What is the most common chief complaint that leads the patient with PID to seek medical health care?
Lower abdominal pain
Pt on bedrest with bathroom privileges and has PID. What is best position for her?
Pt with PID d/c'd home on oral abx. What does the nurse tell the pt regarding her monthly menstrual flow?
Use perineal pads until you are fully recovered
Nurse tells patient with PID about practice of vaginal douching?
Vaginal douching increases a woman's risk for developing PID
Young female pt requires hospitalization for a severe case of genital herpes. What info is given to patient regarding long term consequences?
There is a risk of neonatal transmission and an increased risk for acquiring HIV infection.
Incubation period for genital warts?
2-3 months
Symptoms for gonorrhea in a male patient is?
Dysuria and a profuse yellowish green or scant clear penile d/c
Patient is being treated for gonorrhea. Which single does medication order does the nurse question?
Factors increase risk of PID?
Age younger than 26, multiple sex partners, IUD in place, hx of chlamydia or gonococcal infection
Lab results for patient with PID?
elevated WBC, elevated ESR, presence of more than 10 WBCs per high power field for vaginal d/c
Patient reports itching or tingling sensation felt in the skin 1-2 days followed by a blister on the penis which ruptured spontaneouly with painful erosion. What are those symptoms consistent with?
Genital herpes
Which STD is associated with increased risk for cervical cancer?
Condylomata acuminata: HPV type 16
Genital exam on teenage patient, examiner sees multiple large cauliflower like growths in the perineal area. The patient reports these appeared bout 3 months after her first sexual experience. WHat does the examiner suspect?
Condylomata acuminata (warts)