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Jarvis Chapter 27 Female Genitourinary system
Questions With Complete Solutions
- During a health history, a 22-year old woman asks, "Can I get that vaccine for human papilloma virus (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 years, so we can start that today." b. "This vaccine is only for girls who have not yet started to become sexually active." c. "Let's check with the physician to see if you are a candidate for this vaccine." d. "The vaccine cannot protect you if you already have an HPV infection." D The HPV vaccine is appropriate for girls and women age 9 to 26 years and is administered to prevent cervical cancer by preventing HPV infections before girls become sexually active.
However, it cannot protect the woman if an HPV infection is already present. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 740 MSC: Client Needs: General
- 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 (Skene) and vestibular (Bartholin) glands. A The labial structures encircle a boat-shaped space, or cleft, termed the vestibule. Within the vestibule are numerous openings. The urethral meatus and vaginal orifice are visible. The ducts of the paraurethral (Skene) glands and the vestibular (Bartholin) glands are present but not visible. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 737
Anteverted and anteflexed. b. Retroverted and anteflexed. c. Retroverted and retroflexed. d. Superiorverted and anteflexed. A The uterus is freely movable, not fixed, and usually tilts forward and superior to the bladder (a position labeled as anteverted and anteflexed). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 738 MSC: Client Needs: General
- An 11-year-old girl is in the clinic for a sports physical examination. 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 best assist the young girl in understanding the expected sequence for development? The nurse should: a. Use the Tanner scale on the five stages of sexual development. b. Describe her development and compare it with that of other girls
her age. c. Use the Jacobsen table on expected development on the basis of height and weight data. d. Reassure her that her development is within normal limits and tell her not to worry about the next step. ANS: A The Tanner scale 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. DIF: Cognitive Level: Applying (Application) REF: p. 739 MSC: Client Needs: Health Promotion and Maintenance
- 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; Hegar b. Hegar; Goodell c.
d. Able to respond to estrogen. 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. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 740 MSC: Client Needs: Health Promotion and Maintenance
- The nurse is reviewing the changes that occur with menopause. Which changes are associated with menopause? a. Uterine and ovarian atrophy, along with a thinning of the vaginal epithelium b. Ovarian atrophy, increased vaginal secretions, and increasing clitoral size c. Cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal secretions d. Vaginal mucosa fragility, increased acidity of vaginal secretions, and uterine hypertrophy
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; consequently, the uterus droops. The cervix shrinks and looks paler with a thick glistening epithelium. The vaginal epithelium atrophies, becoming thinner, drier, and itchy. The vaginal pH becomes more alkaline, and secretions are decreased, which results in a fragile mucosal surface that is at risk for vaginitis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 740 MSC: Client Needs: Health Promotion and Maintenance
- 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 disease than a younger woman." b. Should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions."
d. Sexual history, because discussing it first will build rapport. A Menstrual history is usually nonthreatening and therefore a good topic with which to begin the interview. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start. DIF: Cognitive Level: Applying (Application) REF: p. 740 MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A patient has had three pregnancies and two live births. The nurse would record this information as grav _____, para _____, AB _____. a. 2; 2; 1 b. 3; 2; 0 c. 3; 2; 1 d. 3; 3; 1 C Gravida (grav) is the number of pregnancies. Para is the number
of births. Abortions are interrupted pregnancies, including elective abortions and spontaneous miscarriages. DIF: Cognitive Level: Applying (Application) REF: p. 741 MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- During the interview with a female patient, the nurse gathers data that indicate 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." b. "I will be very happy when I can stop worrying about having a period." c. "I have been noticing that I sweat a lot more than I used to, especially at night." d. "I have only been pregnant twice, but both times I had breast tenderness as my first symptom." 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,
vaginal bleeding. The other responses are not correct. DIF: Cognitive Level: Applying (Application) REF: p. 741 MSC: Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies
- 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 incontinence. 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 that occurs as a result of an overactive detrusor muscle in the bladder that contracts and causes an urgent need to void.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 742 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation
- 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 normal." b. "Have you been engaging in unprotected sexual intercourse?" c. "I'd like some information about the discharge. What color is it?" d. "Have you had any urinary incontinence associated with the discharge?" C Questions that help the patient reveal more information about her symptoms should be asked in a nonthreatening manner. Asking about the amount, color, and odor of the vaginal discharge provides the opportunity for further assessment. Normal vaginal discharge is small, clear or cloudy, and always
MSC: Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies
- 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 with their sexual relationships. Would it be okay to discuss this now?" c. "Women often have questions about their sexual relationship and how it affects their health. Do you have any questions?" d. "Most women your age have had more than one sexual partner. How many would you say you have had?" 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 health history, because doing so communicates that the nurse accepts the individual's sexual activity and believes it is important. The nurse's comfort with the discussion prompts the patient's interest and, possibly, relief
that the topic has been introduced. The initial discussion establishes a database for comparison with any future sexual activities and provides an opportunity to screen sexual problems. DIF: Cognitive Level: Applying (Application) REF: p. 742 MSC: Client Needs: Psychosocial Integrity
- A 22-year-old woman has been considering using oral contraceptives. As a part of her health 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 carefully thought this choice through?" d. "If you smoke, how many cigarettes do you smoke per day?" D Oral contraceptives, together with cigarette smoking, increase the risk for cardiovascular side effects. If cigarettes are used, then the nurse should assess the patient's smoking history. The other questions are not appropriate. DIF: Cognitive Level: Applying (Application) REF: p. 743
DIF: Cognitive Level: Applying (Application) REF: p. 743 MSC: Client Needs: Psychosocial Integrity
- 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 sexual intercourse?" c. "Do you have a sexually transmitted infection?" d. "You are aware of the dangers of unprotected sex, aren't you?" B In reviewing a patient's risk for STIs, the nurse should ask in a nonconfrontational manner whether condoms are being used during each episode of sexual intercourse. Asking a person whether he or she has an infection does not address the risk. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 743 MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential
- When the nurse is interviewing a preadolescent girl, which opening question 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 changing?" d. "I remember being very scared when I got my period. How do you think you'll feel?" C Open-ended questions such as, "When did you ...?" rather than "Do you ...?" should be asked. Open-ended questions are less threatening because they imply that the topic is normal and unexceptional. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 743 MSC: Client Needs: Psychosocial Integrity
- When the nurse is discussing sexuality and sexual issues with an adolescent, a permission statement helps convey that it is normal to think or feel a certain way. Which statement is the best example of a permission statement?
