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1

The nurse is providing teaching by telephone to a patient who is scheduled for a pelvic examination and Pap test next week. The nurse instructs the patient that she should

a. shower, but not take a tub bath, before the examination.
b. not have sexual intercourse the day before the Pap test.
c. avoid douching for at least 24 hours before the examination.
d. schedule to have the Pap test just after her menstrual period.

ANS: C
Enlargement of the prostate blocks the urethra, leading to urinary changes such as a decrease in the force of the urinary stream. The other questions address possible problems with infection or sexual difficulties, but they would not be helpful in determining whether there were functional changes caused by BPH.

2

After a 26-year-old patient has been treated for pelvic inflammatory disease, the nurse will plan to teach about

a. use of hormone therapy (HT).
b. irregularities in the menstrual cycle.
c. changes in secondary sex characteristics.
d. possible difficulty with becoming pregnant.

ANS: D
Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HT, have irregular menstrual cycles, or experience changes in secondary sex characteristics.

3

A 68-year-old male patient tells the nurse that he is worried because he does not respond to sexual stimulation the same way he did when he was younger. The nurse's best response to the patient's concern is which of the following?

a. "Interest in sex frequently decreases as men get older."
b. "Many men need additional sexual stimulation with aging."
c. "Erectile dysfunction is a common problem with older men."
d. "Tell me more about how your sexual response has changed."

ANS: D
The initial response by the nurse should be further assessment of the problem. The other statements by the nurse are accurate but may not respond to the patient's concerns

4

The nurse is providing teaching by telephone to a patient who is scheduled for a pelvic examination and Pap test next week. The nurse instructs the patient that she should

a. shower, but not take a tub bath, before the examination.
b. not have sexual intercourse the day before the Pap test.
c. avoid douching for at least 24 hours before the examination.
d. schedule to have the Pap test just after her menstrual period.

ANS: C
Because the results of a Pap test may be affected by douching, the patient should not douche before the examination. The exam may be scheduled without regard to the menstrual period. The patient may shower or bathe before the examination. Sexual intercourse does not affect the results of the examination or Pap test

5

A 22-year-old patient reports her concern about not having a menstrual period for the past 7 months. Which statement by the patient indicates a possible related factor to the amenorrhea?

a. "I drink at least 3 glasses of nonfat milk every day."
b. "I run 7 to 8 miles every day to keep my weight down."
c. "I was treated for a sexually transmitted infection 2 years ago."
d. "I am not sexually active but currently I have an IUD."

ANS: B
Excessive exercise can cause amenorrhea. The other statements by the patient do not suggest any urgent teaching needs

6

The nurse is assessing the sexual-reproductive functional health pattern of a 32-year-old woman. Which question is most useful in determining the patient's sexual orientation and risk factors?

a. "Do you have sex with men, women, or both?"
b. "Which gender do you prefer to have sex with?"
c. "What types of sexual activities do you prefer?"
d. "Are you heterosexual, homosexual, or bisexual?"

ANS: A
This question is the most simply stated and will increase the likelihood of obtaining the relevant information about sexual orientation and possible risk factors associated with sexual activity. A patient who prefers sex with women may also have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have sex with both men and women do not identify themselves as homosexual or bisexual.

7

The nurse explains to a 37-year-old patient being prepared for colposcopy with a cervical biopsy that the procedure

a. involves dilation of the cervix and biopsy of the tissue lining the uterus.
b. will take place in a same-day surgery center so that local anesthesia can be used.
c. requires that the patient have nothing to eat or drink for 6 hours before the procedure.
d. is similar to a speculum examination of the cervix and should result in little discomfort.

ANS: D
Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. Anesthesia is not required and fasting is not necessary. A cervical biopsy may cause a minimal amount of pain

8

A couple is scheduled to have a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about

a. being sedated during the procedure.
b. determining the estimated time of ovulation.
c. experiencing shoulder pain after the procedure.
d. refraining from intercourse before the appointment.

ANS: B
For the Huhner test, the couple should have intercourse at the estimated time of ovulation and then arrive for the test 2 to 8 hours after intercourse. The other instructions would be used for other types of fertility testing

9

A 44-year-old patient in the sexually transmitted infection clinic has a positive Venereal Disease Research Laboratory (VDRL) test, but no chancre is visible on assessment. The nurse will plan to send specimens for

a. gram stain.
b. cytologic studies.
c. rapid plasma reagin (RPR) agglutination.
d. fluorescent treponemal antibody absorption (FTA-Abs).

ANS: D
Because false positives are common with VDRL and RPR testing, FTA-Abs testing is recommended to confirm a diagnosis of syphilis. Gram staining is used for other sexually transmitted infections (STIs) such as gonorrhea and Chlamydia and cytologic studies are used to detect abnormal cells (such as neoplastic cells).

10

A 24-year-old female says she wants to begin using oral contraceptives. Which information from the nursing assessment is most important to report to the health care provider?

a. The patient quit smoking 5 months previously.
b. The patient's blood pressure is 154/86 mm Hg.
c. The patient has not been vaccinated for rubella.
d. The patient has chronic iron-deficiency anemia.

ANS: B
Because hypertension increases the risk for morbidity and mortality in women taking oral contraceptives, the patient's blood pressure should be controlled before oral contraceptives are prescribed. The other information also will be reported but will not affect the choice of contraceptive

11

A 49-year-old man who has type 2 diabetes, high blood pressure, hyperlipidemia, and gastroesophageal reflux tells the nurse that he has had recent difficulty in achieving an erection. Which of the following drugs from his current medications list may cause erectile dysfunction (ED)?

a. Ranitidine (Zantac)
b. Atorvastatin (Lipitor)
c. Propranolol (Inderal)
d. Metformin (Glucophage)

ANS: C
Some antihypertensives may cause erectile dysfunction, and the nurse should anticipate a change in antihypertensive therapy. The other medications will not affect erectile function

12

A 19-year-old patient calls the school clinic and tells the nurse, "My menstrual period is very heavy this time. I have to change my tampon every 4 hours." Which action should the nurse take next?

a. Tell the patient that her flow is not unusually heavy.
b. Schedule the patient for an appointment later that day.
c. Ask the patient how heavy her usual menstrual flow is.
d. Have the patient call again if the heavy flow continues.

ANS: C
Because a heavy menstrual flow is usually indicated by saturating a pad or tampon in 1 to 2 hours, the nurse should first assess how heavy the patient's usual flow is. There is no need to schedule the patient for an appointment that day. The patient may need to call again, but this is not the first action that the nurse should take. Telling the patient that she does not have a heavy flow implies that the patient's concern is not important

13

After scheduling a patient with a possible ovarian cyst for ultrasound, the nurse will teach the patient that she should

a. expect to receive IV contrast during the procedure.
b. drink several glasses of fluids before the procedure.
c. experience mild abdominal cramps after the procedure.
d. discontinue taking aspirin for 7 days before the procedure.

ANS: B
A full bladder is needed for many ultrasound procedures, so the nurse will have the patient drink fluids before arriving for the ultrasound. The other instructions are not accurate for this procedure

14

The nurse will plan to teach a 51-year-old man who is scheduled for an annual physical exam about a(n)

a. increased risk for testicular cancer.
b. possible changes in erectile function.
c. normal decreases in testosterone level.
d. prostate specific antigen (PSA) testing.

ANS: D
PSA testing may be recommended annually for men, starting at age 50. There is no indication that the other patient teaching topics are appropriate for this patient

15

department after a motor vehicle crash is scheduled for chest and abdominal x-rays. Which information is most important to report to the health care provider before the x-rays are obtained?

a. Severity of abdominal pain
b. Positive result of hCG test
c. Blood pressure 172/88 mm Hg
d. Temperature 102.1° F (38.9° C)

ANS: B
Positive hCG testing indicates that the patient is pregnant and that unnecessary abdominal x-rays should be avoided. The other information is also important to report, but it will not affect whether the x-rays should be done

16

The following patients call the outpatient clinic. Which phone call should the nurse return first?

a. A 44-year-old patient who has bloody discharge after a hysteroscopy earlier today
b. A 64-year-old patient who is experiencing shoulder pain after a laparoscopy yesterday
c. A 34-year-old patient who is short of breath after pelvic computed tomography (CT) with contrast
d. A 54-year-old patient who has severe breast tenderness following a needle aspiration breast biopsy

ANS: C
The patient's dyspnea suggests a delayed reaction to the iodine dye used for the CT scan. The other patient's symptoms are not unusual after the procedures they had done.

17

A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated three tampons in the past 2 hours. The nurse estimates that the amount of blood loss over the past 2 hours is _____ mL.

a. 20 to 30
b. 30 to 40
c. 40 to 60
d. 60 to 90

ANS: D
The average tampon absorbs 20 to 30 mL.

18

Which finding from the nurse's physical assessment of a 42-year-old male patient should be reported to the health care provider?

a. One testis hangs lower than the other.
b. Genital hair distribution is diamond shaped.
c. Clear discharge is present at the penile meatus.
d. Inguinal lymph nodes are nonpalpable bilaterally.

ANS: C
Clear penile discharge may be indicative of a sexually transmitted infection (STI). The other findings are normal and do not need to be reported