Repro 3

Created by johnbell 

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1. During a routine health examination, a 35-year-old woman who uses oral contraceptives tells the nurse, "I want to have children, but I want to wait a few more years." Which response by the nurse is appropriate?
a. "Because of your age, you may need to stop taking oral contraceptives several years before you want to become pregnant."
b. "You still have many years of fertility left, so there is no rush to have children."
c. "You may have more difficulty becoming pregnant after about age 35."
d. "If you do not have children within the next few years, it will be very difficult for you to become pregnant."

: C
Rationale: The probability of successfully becoming pregnant decreases after age 35, 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 Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant.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 indicate that there is no concern about infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving.

Cognitive Level: Application Text Reference: p. 1382
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

2. A couple has undergone infertility evaluation with no success at conception and is considering the possibility of in vitro fertilization (IVF). The wife tells the nurse that they really cannot afford IVF on her husband's salary, and the husband replies that if his wife would get a job, maybe they would have enough money for the procedure. Which nursing diagnosis is appropriate for the couple?
a. Defensive coping related to anxiety about lack of conception
b. Ineffective sexuality patterns related to psychological stress
c. Ineffective denial related to frustration about continued infertility
d. Ineffective role performance related to inadequate finances

: A
Rationale: The statements made by the couple are consistent with the diagnosis of defensive coping. There are no data to indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data in the stem do not provide information indicating that the finances are inadequate.


Cognitive Level: Application Text Reference: p. 1383
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

3. A young woman who is trying to become pregnant asks the nurse about ways to determine when she is most likely to conceive. The nurse explains that
a. she should take her body temperature daily and have intercourse when it drops.
b. she will need to bring a specimen of cervical mucus to the clinic for testing.
c. ovulation prediction kits provide accurate information about ovulation.
d. ovulation is difficult to predict unless she has regular menstrual periods.

: C
Rationale: Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise and ovulation occurs about 28 to 36 hours after ovulation; the kits 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.

Cognitive Level: Application Text Reference: p. 1382
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

4. A woman has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient?
a. "You should abstain from sexual intercourse for 2 weeks."
b. "Use of contraceptives should be avoided until your reexamination."
c. "Heavy vaginal bleeding is expected for about 2 weeks."
d. "Irregular menstrual periods are expected for the next few months."

: A
Rationale: Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination 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.

Cognitive Level: Comprehension Text Reference: p. 1385
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

5. A woman is scheduled for a late-induced abortion using instillation of hypertonic saline solution. Before the procedure, which information will the nurse discuss with the patient?
a. There is a possibility that the patient may deliver a live fetus.
b. The expulsion of the fetus may take up to a day or longer.
c. The procedure may be unsuccessful in terminating the pregnancy.
d. The patient will require a general anesthetic for the procedure.

: B
Rationale: 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 termination will not be successful. General anesthesia is not needed for this procedure.

Cognitive Level: Application Text Reference: p. 1384
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

6. A 31-year-old woman tells the nurse that she has noticed increasing headaches with dizziness, abdominal bloating, and unexplained anxiety occurring before her menstrual periods. Which action by the nurse is most appropriate?
a. Teaching the patient about lifestyle changes to reduce premenstrual syndrome (PMS) symptoms
b. Suggesting that the patient use ibuprofen (Advil) to control symptoms
c. Telling the patient that her symptoms may be caused by PMS and that relaxation therapy may provide symptom relief
d. Scheduling the patient for an appointment in 3 months and have her write down symptoms for the next three menstrual cycles

: D
Rationale: Having the patient keep a menstrual diary for 2 or 3 months will help in making a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made and PMS can be diagnosed only after other reasons for the symptoms have been ruled out.

Cognitive Level: Application Text Reference: p. 1385
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

7. A 19-year-old requests a prescription for birth control pills at the student health center. She tells the nurse that she wants to take birth control pills to decrease the pain and headaches she has during her menstrual periods. The most appropriate response by the nurse is,
a. "In order to obtain birth control pills, you will need to provide information about sexual history."
b. "You should try other techniques to control the pain before any type of drug therapy is used."
c. "Birth control pill use should be restricted to more serious problems because of the side effects they can cause."
d. "Birth control pills can be effective treatment for painful menstruation, and it may be possible for you to use them."

: D
Rationale: Oral contraceptives decrease dysmenorrhea and are appropriate for the patient's symptoms. Sexual history is not relevant when prescribing birth control pills for this purpose, and the patient is not required to provide this information. Other techniques may be tried, but oral contraceptives are a possible first-line therapy. The nurse should not appear to indicate that the patient's problems are not serious; in addition, the side effects of birth control pills are minimal for most women.

Cognitive Level: Application Text Reference: p. 1387
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

8. When teaching a patient about ways to prevent primary dysmenorrhea, the nurse will suggest that the patient
a. avoid aerobic exercise during her menstrual period.
b. use cold packs on the abdomen and back for pain relief.
c. start taking nonsteroidal antiinflammatory drugs (NSAIDs) regularly when her menstrual period starts.
d. talk with her health care provider about antidepressant therapy.

: C
Rationale: NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.

Cognitive Level: Application Text Reference: p. 1387
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

9. A 26-year-old woman is admitted to the hospital with abdominal cramping and vaginal bleeding. She is diagnosed with an ectopic pregnancy in the fallopian tube. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action by the nurse is appropriate?
a. Staying with the patient and assessing the patient's emotional status frequently
b. Explaining the reason for taking the patient's vital signs every 15 to 30 minutes
c. Closing the door to the patient's room and not disturbing her for a few hours
d. Providing teaching about surgical interventions for ectopic pregnancy

: B
Rationale: Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and assessing her emotional status frequently is inappropriate. Leaving the patient alone for several hours is unsafe because of the risk for hemorrhage. Because nonsurgical options to terminate the pregnancy are available, preoperative teaching is inappropriate until it is determined that the patient will actually have surgery.

Cognitive Level: Application Text Reference: p. 1390
Nursing Process: Implementation NCLEX: Physiological Integrity

10. When caring for a 60-year-old patient with persistent menorrhagia, the nurse will plan to monitor the
a. estrogen level.
b. complete blood count (CBC).
c. gonadotropin-releasing hormone (GNRH) level.
d. serial -human chorionic gonadotropin (hCG) results.

: B
Rationale: Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial -hCG levels are monitored in patients with an ectopic pregnancy, which is not likely for this patient.

Cognitive Level: Application Text Reference: p. 1389
Nursing Process: Assessment NCLEX: Physiological Integrity

11. A 46-year-old woman tells the nurse that she has not had a menstrual period for 3 months and asks whether she is going into menopause. The best response by the nurse is,
a. "Are you experiencing any other signs of low estrogen levels?"
b. "What was your menstrual pattern before your periods stopped?"
c. "The doctor can prescribe hormone replacement therapy to minimize menopausal symptoms."
d. "Menopause is unlikely at age 46, so your amenorrhea needs further investigation."

: B
Rationale: The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Asking the patient about other signs of low estrogen is inappropriate because the patient may not know the symptoms associated with low estrogen levels. Although hormone-replacement therapy (HRT) may be prescribed, further assessment and teaching about the benefits and risks of HRT are needed before encouraging the patient to use this therapy. Menopause sometimes starts in the 40s.

Cognitive Level: Application Text Reference: pp. 1390-1391
Nursing Process: Implementation NCLEX: Physiological Integrity

12. A 42-year-old woman has developed amenorrhea. If the woman is experiencing menopause, the nurse would expect laboratory findings to include
a. decreased serum estrogen.
b. elevated progesterone level.
c. presence of hCG in the urine.
d. low serum follicle-stimulating hormone (FSH) level.

: A
Rationale: When the ovarian follicles no longer respond to FSH, ovarian production of estrogen and progesterone decreases. The lack of feedback causes FSH levels to increase. The level of hCG increases in pregnancy.

Cognitive Level: Comprehension Text Reference: p. 1390
Nursing Process: Assessment NCLEX: Physiological Integrity

13. To help a 53-year-old woman make a decision about the use of combined estrogen-progesterone hormone replacement therapy (HRT) to control the effects of menopause, the nurse explains that
a. the use of estrogen-containing vaginal creams provides most of the same benefits as oral HRT.
b. HRT decreases osteoporosis risk, but it increases the risk for cardiovascular disease and breast cancer.
c. most perimenopausal women use HRT for 5 to 10 years to prevent hot flashes and mood changes.
d. an increased incidence of colon cancer in women taking HRT requires frequent stool assessment for occult blood.

: B
Rationale: Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

Cognitive Level: Application Text Reference: p. 1391
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

14. After teaching a perimenopausal patient who has started using hormone replacement therapy (HRT), the nurse determines that the teaching has been effective when the patient says
a. "If I take a daily aspirin, I will not need to worry about blood clots."
b. "Now that I have started taking HRT, I can stop taking calcium supplements."
c. "My breasts may feel tender when I am taking the HRT."
d. "I will continue to have menstrual periods, but the blood flow will be lighter."

: C
Rationale: Breast tenderness is a potential side effect of HRT. Daily aspirin therapy does not eliminate the risk for deep vein thrombosis (DVT) or pulmonary emboli in women taking HRT, and they should be taught to monitor for symptoms of these adverse effects. Continued calcium supplementation is needed to reduce osteoporosis risk. The patient will not have regular menstrual periods and should call the health care provider about vaginal bleeding.

Cognitive Level: Application Text Reference: p. 1391
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

15. After being sexually assaulted, a woman is brought to the emergency department by a friend. The patient is confused and has a large laceration and ecchymosis above the left eye. Which action should the nurse take first?
a. Ask the patient to describe what occurred during the assault.
b. Assist the patient in removing her clothing.
c. Contact the sexual assault nurse examiner (SANE).
d. Assess the patient's neurologic status.

: D
Rationale: The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a skull fracture, subdural hematoma, or other. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury.

Cognitive Level: Application Text Reference: p. 1410
Nursing Process: Implementation NCLEX: Physiological Integrity

16. Six months after being sexually assaulted, a woman tells the nurse that she has nightmares about the incident and develops acute anxiety if she finds herself alone in situations where several men are present. The most appropriate nursing diagnosis for the patient is
a. sleep deprivation related to frightening dreams.
b. ineffective coping related to inability to resolve rape incident.
c. anxiety related to effects of being raped.
d. rape-trauma syndrome related to rape experience.

: D
Rationale: The patient's symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis.

Cognitive Level: Application Text Reference: p. 1409
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

17. A diagnosis of candidiasis is made when a patient with an abnormal vaginal discharge is seen at the clinic, and an antifungal vaginal cream is prescribed. Which statement by the patient indicates that teaching about the candidiasis treatment has been effective?
a. "I will tell my husband that we cannot have sex for the next month."
b. "I should clean my perineal area carefully after each urination and bowel movement."
c. "I can douche with warm water if the itching continues to bother me."
d. "I will use the applicator to insert the cream before I get out of bed in the morning."

: B
Rationale: Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer.

Cognitive Level: Application Text Reference: pp. 1393-1394
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

18. While obtaining a health history from a patient hospitalized with pelvic inflammatory disease (PID), the nurse recognizes that a risk factor related by the patient includes
a. the use of oral contraceptives.
b. sexual exposure to a partner with urethritis.
c. use of superabsorbent tampons.
d. history of long-term antibiotic treatment.

: B
Rationale: Exposure to a male partner with urethritis (which suggests infection with a sexually transmitted disease [STD]) introduces the bacteria into the vagina and cervix, allowing the organism to ascend to the other reproductive structures. Oral contraceptive use, use of superabsorbent tampons, and long-term antibiotic therapy do not increase risk for PID.

Cognitive Level: Comprehension Text Reference: p. 1396
Nursing Process: Assessment NCLEX: Physiological Integrity

19. When the nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization, which nursing intervention will be included in the plan of care?
a. Monitoring liver function tests
b. Elevating the head of the bed to at least 30 degrees
c. Using cold packs PRN pelvic pain
d. Teaching how to perform Kegel exercises

: B
Rationale: The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.

Cognitive Level: Application Text Reference: p. 1396
Nursing Process: Planning NCLEX: Physiological Integrity

20. A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral antibiotics. When teaching the patient about follow-up care and management of her condition, the nurse instructs the patient that
a. sexual intercourse should be avoided for 1 week.
b. a follow-up appointment is needed in 2 to 3 days.
c. abdominal pain may persist for several weeks.
d. NSAID use may prevent scarring of pelvic organs.

: B
Rationale: The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help to prevent inflammation and scarring, but NSAIDs will not decrease scarring.

Cognitive Level: Application Text Reference: p. 1396
Nursing Process: Implementation NCLEX: Physiological Integrity

21. When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the patient to
a. take the medication every day for the next 9 months.
b. expect to experience symptoms such as facial hair.
c. use a second method of contraception to ensure that she will not become pregnant.
d. take calcium supplements to prevent osteoporosis from developing during therapy.

: A
Rationale: When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

Cognitive Level: Application Text Reference: p. 1397
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

22. A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse explains that this therapy
a. suppresses the menstrual cycle by mimicking pregnancy.
b. may cause symptoms such as vaginal atrophy and hot flashes.
c. will lead to permanent suppression of abnormal endometrial tissues.
d. is associated with loss of bone density and increased fracture risk.

: A
Rationale: Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss.

Cognitive Level: Application Text Reference: p. 1397
Nursing Process: Implementation NCLEX: Physiological Integrity

23. When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most important for the nurse to teach the patient
a. ways to reduce the occurrence of acne.
b. how to decrease facial hair growth.
c. methods to maintain appropriate weight.
d. reasons for a total hysterectomy.

: C
Rationale: Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse will also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, this is usually performed only after other therapies have been unsuccessful.

Cognitive Level: Application Text Reference: p. 1400
Nursing Process: Implementation NCLEX: Physiological Integrity

24. A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate scheduling the patient for
a. endometrial biopsy.
b. dilation and curettage (D&C).
c. laser endometrial ablation.
d. uterine balloon therapy.

: A
Rationale: A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

Cognitive Level: Application Text Reference: p. 1402
Nursing Process: Implementation NCLEX: Physiological Integrity

25. Stage III ovarian cancer is diagnosed in a 63-year-old woman. A nursing diagnosis that is likely to be appropriate is
a. sexual dysfunction related to loss of vaginal sensation.
b. risk for infection related to impaired immune function.
c. anxiety related to cancer diagnosis and need to make treatment decisions.
d. situational low self-esteem related to guilt about delaying medical care.

: C
Rationale: The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

Cognitive Level: Application Text Reference: p. 1403
Nursing Process: Diagnosis NCLEX: Physiological Integrity

26. When caring for a patient who has a radium implant for treatment of cancer of the cervix, the nurse will plan to
a. use gloves when changing the patient's bed.
b. maintain the patient on complete bed rest.
c. flush the toilet several times after the patient voids to eliminate radioactive isotopes.
d. allow adequate time for discussion of patient concerns about the cancer diagnosis.

: B
Rationale: To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when changing linens is not necessary because the isotope is confined to the implant. The patient will not get out of bed to void. The nurse will spend minimal time in the patient's room to avoid exposure to radiation.

Cognitive Level: Application Text Reference: p. 1405
Nursing Process: Implementation
NCLEX: Safe and Effective Care Environment

27. During assessment of a patient with suspected endometrial cancer, the nurse identifies an important risk factor for cancer of the endometrium when the patient's history includes
a. alcohol addiction.
b. multiple pregnancies.
c. long-standing obesity.
d. early sexual activity.

: C
Rationale: Because adipose cells store estrogen, obesity is a risk factor for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies offer protection from endometrial cancer. Early sexual activity is associated with increased cervical cancer risk, but it does not increase risk for endometrial cancer.

Cognitive Level: Comprehension Text Reference: p. 1401
Nursing Process: Assessment NCLEX: Physiological Integrity

28. A 62-year-old patient with stage 0 carcinoma of the cervix that was determined by cervical conization has been told by her health care provider she needs no further treatment at this time. She asks the nurse why the doctor has not discussed other treatment options with her. The most appropriate response by the nurse is,
a. "Because of your age, further treatment of the cervical cancer is not indicated."
b. "Stage 0 tumors take many years to spread, so you only need periodic examinations at this time."
c. "Conization is used both to diagnose and to treat cervical cancer, so no further treatment is needed."
d. "Unless the human papilloma virus (HPV) tests are positive, there is no indication that more treatment is needed."

: C
Rationale: Because conization involves excision of the abnormal area of the cervix, it can be used for both diagnosis and treatment. Although the patient's age is considered when choosing treatment for cervical cancer, the staging for this patient indicates that no further treatment is needed. The second statement indicates that there is still cervical cancer present, which is not the case with stage 0 cervical cancer. HPV infection does increase the risk for cervical cancer, but it does not impact whether further treatment is needed for this patient.

Cognitive Level: Application Text Reference: p. 1401
Nursing Process: Implementation NCLEX: Physiological Integrity

29. A patient's Pap test reveals cervical cells characteristic of adenocarcinoma of the cervix. Information obtained during the patient's health history and identified as a major risk factor for cervical cancer is
a. smoking coupled with infection with a human papilloma virus (HPV).
b. use of estrogen replacement therapy for menopausal symptoms.
c. the patient's use of oral contraceptives for 15 years.
d. a history of four pregnancies with one spontaneous abortion.

: A
Rationale: Smoking and HPV infection are both associated with increased cervical cancer risk. Estrogen therapy, oral contraceptive use, and multiple pregnancies do not increase risk.

Cognitive Level: Application Text Reference: p. 1400
Nursing Process: Assessment NCLEX: Physiological Integrity

30. An abdominal hysterectomy is scheduled for a 40-year-old patient with multiple uterine leiomyomas. Before the surgery, the nurse will teach the patient about
a. the expected temporary loss of vaginal sensation.
b. use of a heat lamp to help dry the open wound area.
c. symptoms caused by the sudden drop in estrogen level.
d. leg exercises and the purpose of frequent ambulation.

: D
Rationale: Deep vein thrombosis (DVT) is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent DVT. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. The patient will have an incision rather than an open wound. Because the patient will still have her ovaries, the estrogen level will not decrease.

Cognitive Level: Application Text Reference: p. 1406
Nursing Process: Implementation NCLEX: Physiological Integrity

31. When assessing a patient on her return to the surgical unit following a total abdominal hysterectomy, the nurse would expect to find
a. complaints of abdominal pain at the incision site with repositioning.
b. scant urine output from the retention catheter for the first 8 hours.
c. a heavy pressure dressing in place across the lower abdomen.
d. a moderate amount of sanguineous drainage on the abdominal dressing.

: A
Rationale: Abdominal pain after this surgery is expected. A urine output of at least 30 to 60 ml/hr is expected. A pressure dressing is not needed after a total abdominal hysterectomy. Moderate sanguineous drainage on the abdominal dressing may indicate postoperative hemorrhage.

Cognitive Level: Application Text Reference: p. 1398
Nursing Process: Assessment NCLEX: Physiological Integrity

32. A patient who has undergone a vaginal hysterectomy has not voided for 8 hours following surgery and is complaining of bladder distention. The most appropriate action by the nurse is to
a. insert a straight catheter per the PRN order.
b. increase the patient's oral fluid intake to 200 ml/hr.
c. notify the health care provider of the patient's inability to void.
d. ambulate the patient short distances every hour.

: A
Rationale: After hysterectomy, the patient may experience urinary retention caused by temporary bladder atony; catheterization is needed if the patient has not voided for 8 hours. Increasing the patient's fluid is not appropriate when the bladder is distended. There is an order to catheterize the patient, so the nurse does not need to notify the health care provider. Ambulation will be uncomfortable for the patient with a full bladder.

Cognitive Level: Application Text Reference: p. 1406
Nursing Process: Implementation NCLEX: Physiological Integrity

33. The nurse obtains all these data when assessing a patient who returned to the surgical unit after having a total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 hours ago. Which information is most important to communicate to the surgeon?
a. The abdominal dressing has a 1-cm area of dark red drainage.
b. The catheter drainage bag shows a total of 100 ml of urine since surgery.
c. The patient is complaining of 5/10 continuous abdominal pain.
d. The patient has decreased bowel tones and abdominal distension.

: B
Rationale: The low urine output may indicate that a ureter has been ligated during the surgery, and the patient may need to return to surgery. Another possibility is that she is hypovolemic secondary to blood loss. The other data are not unusual after surgery and require nursing interventions such as ongoing monitoring and administration of pain medications but do not require rapid action by the health care provider.

Cognitive Level: Application Text Reference: p. 1406
Nursing Process: Assessment NCLEX: Physiological Integrity

34. A patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. In planning care for the patient, the nurse identifies a priority nursing diagnosis of
a. risk for infection related to contamination of the wound with urine and stool.
b. self-care deficit: bathing/hygiene related to pain and difficulty in changing position.
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.

: A
Rationale: 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.

Cognitive Level: Application Text Reference: p. 1406
Nursing Process: Diagnosis NCLEX: Physiological Integrity

35. A 56-year-old woman undergoes an anterior and posterior (A & P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan?
a. Repositioning of the rectal tube for comfort
b. Teaching the patient correct pessary use
c. Repacking the vaginal wound with half-inch gauze
d. Performing indwelling catheter care daily

: D
Rationale: The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A & P repair.

Cognitive Level: Application Text Reference: p. 1408
Nursing Process: Assessment NCLEX: Physiological Integrity

36. A 56-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which response by the nurse is most appropriate?
a. "Breakthrough bleeding is normal in women your age."
b. "Are you using prescription hormone replacement therapy?"
c. "How long has it been since your last menstrual period?"
d. "A frequent cause of spotting is endometrial cancer."

: B
Rationale: In postmenopausal women, a common cause of spotting is hormone replacement therapy (HRT). Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse should not tell the patient that it is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

Cognitive Level: Application Text Reference: p. 1388
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

37. An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which question should the nurse ask?
a. "How old were you when your menstrual periods started?"
b. "Do you have any pain or cramping with your menstrual periods?"
c. "Have you ever had sexual intercourse?"
d. "Do you use any illegal substances?"

: C
Rationale: The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21. The information about menstrual periods and substance abuse will not help to determine whether the patient requires a Pap test.

Cognitive Level: Application Text Reference: p. 1400
Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

38. Which information will the nurse include when developing a patient teaching plan for a 48-year-old patient with uterine bleeding caused by a leiomyoma?
a. Over-the-counter pain relievers such as aspirin are appropriate to use if mild pain occurs.
b. The tumor size is likely to increase throughout the patient's lifetime.
c. The patient will need frequent monitoring to detect any malignant changes.
d. The symptoms may decrease after the patient undergoes menopause.

: D
Rationale: Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

Cognitive Level: Application Text Reference: p. 1398
Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

39. A patient who is seen in the health clinic is diagnosed with genital warts. The nurse will plan to teach the patient about
a. the need for regular Pap tests.
b. symptoms of pelvic inflammatory disease.
c. appropriate use of oral contraceptives.
d. increased risk for endometrial cancer.

: A
Rationale: Genital warts are caused by the human papilloma virus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer.

Cognitive Level: Application Text Reference: p. 1400
Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

40. The nurse has just received change-of-shift report about these four patients. Which patient should be assessed first?
a. A patient in the 15th week of gestation who is experiencing uterine cramping and spotting
b. A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain
c. A patient with ovarian cancer who is complaining of 5/10 pain after a total abdominal hysterectomy and bilateral salpingo-oophorectomy
d. A patient who has a radium implant in place to treat cervical cancer and is crying because she feels isolated in her hospital room

: B
Rationale: 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 also should be assessed as quickly as possible but do not have symptoms of life-threatening complications.

Cognitive Level: Analysis Text Reference: p. 1389
Nursing Process: Assessment
NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. When counseling a healthy perimenopausal woman who prefers not to use hormone replacement therapy (HRT), which nonhormonal therapies will the nurse suggest? (Select all that apply.)
a. Reduce coffee intake.
b. Use warm quilts at night.
c. Take black cohosh supplements.
d. Increase intake of dietary soy products.
e. Have a glass of wine in the evening.
f. Exercise several times a week.

: A, C, D, F
Rationale: Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Because sleeping in a warm room may increase hot flashes, women are advised to sleep in a cool room with good air circulation and lightweight bedding. Alcohol intake in the evening may increase the sleep problems associated with menopause.

Cognitive Level: Comprehension Text Reference: pp. 1392-1393
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

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