Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 6 Women's Health Problems

1. The nurse receives a phone call from a 25-year-old woman experiencing breast tenderness in the week prior to her menses, with palpable breast nodularity, without nipple discharge. What is the best response by the nurse?
2. "Please make an appointment at the breast cancer center as soon as possible."
3. "How much salty food do you regularly consume?"
4. "As long as you don't have nipple discharge, it isn't a serious condition."
5. "Eliminate caffeine and chocolate from your diet."

Page Ref: 91

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A client describes breast swelling and tenderness. What piece of data would be most important for the nurse to gather initially?
2. Timing of the symptoms
3. Birth control method
4. Method of breast self-examination
5. Diet history

Page Ref: 91

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessment of health and illness parameters in patient, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A client is concerned about her risk for breast cancer. Following the initial history, the nurse identifies which of the following as a high risk factor for breast cancer?
2. History of late menarche and early menopause
3. Sister who has had breast cancer
4. Mother with fibrocystic breast disease
5. Multiparity

Page Ref: 93

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅶ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A nurse is providing a client with instructions regarding breast self-examination (B S E). Which of the following statements by the client would indicate that the teaching has been successful?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "I should perform B S E 1 week prior to the start of my period."
2. "When I reach menopause, I will perform B S E every 2 months."
3. "Knowing the density of my breast tissue is important."
4. "I should inspect my breasts while standing with my arms down at my sides."
5. "I should inspect my breasts while in a supine position with my arms at my sides."

Page Ref: 89—90

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is working with a woman who is undergoing chemotherapy for breast cancer. The client states, "First, the cancer seemed unreal. Now I feel like I can cope." What is the nurse's best response?
2. "Women with breast cancer often go through several stages of adjustment."
3. "Women with breast cancer cope better than their partners cope."
4. "Women with breast cancer seek multiple opinions before starting treatment."
5. "Women with breast cancer become angry after treatment begins."

Page Ref: 94

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: Q S E N Competencies: Ⅰ. C. 1. Value seeing healthcare situations "through patient's eyes." | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Describe the emotional reactions a woman may experience in regard to a diagnosis of breast cancer.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse interviews a 28-year-old client with a new medical diagnosis of endometriosis. Which question asked by the nurse is appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Are you having hot flashes?"
2. "Are you experiencing pain during intercourse?"
3. "Is a vaginal discharge present?"
4. "Are you having pain during your period?"
5. "Have you noticed any skin rashes?"

Page Ref: 103

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients using developmentally and culturally appropriate approaches. | N L N Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A woman with polycystic ovarian syndrome (P C O S) is prescribed clomiphene citrate for the treatment of infertility. Which statement does the nurse understand is true?
2. The woman has abnormal ovaries
3. The woman has low prolactin levels
4. The woman's pituitary gland is intact
5. The woman's thyroid gland is normal

Page Ref: 113

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care | A A C N Essentials Competencies: Ⅸ. 3.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Knowledge; 2. Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 12 Summarize the indications for the tests and associated treatments that are performed in an infertility workup.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is teaching a client who has been diagnosed with vulvitis. Which statement by the client indicates that the nurse's instruction has not been effective?
2. "I should stop having sexual intercourse."
3. "Non-deodorized tampons could make this condition recur."
4. "Wearing pantyhose daily will improve the problem."
5. "A different brand of soap might eliminate the irritation."

Page Ref: 96, 97

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Identify the implications of an abnormal finding during a pelvic examination.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The 22-year-old client is scheduled for her first gynecologic examination. What can the nurse do to make the client more comfortable during this exam?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Create a trusting atmosphere.
2. Show the client what the speculum looks like.
3. Avoid telling the client what the exam involves.
4. Ask the client why she has delayed her first Pap test this long.
5. Provide a mirror for the client.

Page Ref: 95

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The 12-year-old client reports that menarche occurred 5 months ago. She has had bleeding every day this month, and is very worried. The nurse should explain that the most common cause of this bleeding is which of the following?
2. Dysfunctional uterine bleeding (D U B)
3. Diabetes mellitus (D M)
4. Pregnancy
5. Von Willebrand's disease

Page Ref: 101

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A nurse is teaching a class on the different types of uterine bleeding. The nurse explains that which of the following is one of the causes of abnormal uterine bleeding?
2. Iron-deficiency anemia
3. Polyps
4. Heavy periods every 2 months
5. Spotting between periods

Page Ref: 102

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse walks in to find the client crying after the physician informed her of her diagnosis of human papilloma virus (H P V). Which statement by the nurse conveys an attitude of acceptance toward the client with a sexually transmitted infection?
2. "Don't worry about it. In a few weeks, with treatment, the lesions will disappear."
3. "You seem upset. I'll get the doctor."
4. "You seem upset. Can I help answer any questions?"
5. "I think you need to see a therapist."

Page Ref: 98

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: Q S E N Competencies: Ⅰ. C. 8. Appreciate the role of the nurse in relief of all types and sources of pain or suffering. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse obtains a health history from four clients. To which client should she give priority for teaching about cervical cancer prevention?
2. Age 37, multiple partners
3. Age 22, abstains from sexual intercourse
4. Age 32, pregnant with twins
5. Age 27, uses female condom

Page Ref: 98

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Teamwork: Clarify roles and integrate the contributions of others who play a role in helping the patient/family achieve health goals. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 3 Identify the implications of an abnormal finding during a pelvic examination.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is about to tell a client that her Pap smear result was abnormal. Which statement should the nurse include?
2. "The Pap smear is used to diagnose cervical cancer."
3. "A loop electrosurgical excision procedure (L E E P) is needed."
4. "Colposcopy to further examine your cervix is the next step."
5. "Your cervix needs to be treated with cryotherapy."

Page Ref: 100

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 1. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The client's Pap smear result is A S C-U S. Which statement is the best way for the nurse to explain this A S C-U S result?
2. "Abnormal cells of an unknown cause."
3. "Cancer has invaded the upper cervix."
4. "High-grade squamous intraepithelial lesion (H S I L), which includes C I N."
5. "The focus of the Pap smear is the detection of high-risk pregnancy."
6. "The cervical cells are abnormal and the reason why is severe dysplasia and carcinoma in situ."

Page Ref: 100

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse has presented a community education class on recommended health screenings for women. Which statement about the Pap smear by a class member indicates that additional teaching is necessary?
2. "It is recommended for women 21 years of age and older."
3. "It diagnoses cervical cancer."
4. "Intercourse at a young age is a risk factor for an abnormal Pap smear."
5. "Detects abnormal cells."

Page Ref: 98

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patient or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. Which client in the gynecology clinic should the nurse see first?
2. 32-year-old taking gonadotropins, reporting extremity edema
3. 15-year-old, no menses for past 4 months
4. 18-year-old seeking information on contraception methods
5. 31-year-old, taking progestins, reports increasing dyspareunia

Page Ref: 113

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 4. Assess presence and extent of pain and suffering. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 12 Summarize the indications for the tests and associated treatments that are performed in an infertility workup.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is caring for a client diagnosed with endometriosis. Which statement by the client would require a need for perhaps another treatment option?
2. "I am having many hot flashes since I had the Lupron injection."
3. "The pain I experience with intercourse is becoming more severe."
4. "I have vaginal dryness, reduced libido, and my clitoris has become larger since taking danazol. Is this normal?"
5. "I've noticed I have not had my period on a regular basis since being on the G n R H analogs."

Page Ref: 103—104

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Self-Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The client diagnosed with endometriosis asks the nurse whether there are any long-term health risks associated with this condition. The nurse should include which statement in the client teaching about endometriosis?
2. "There are no other health risks associated with endometriosis."
3. "Pain with intercourse rarely occurs as a long-term problem."
4. "You are at increased risk for ovarian and breast cancer."
5. "Most women with this condition develop severe migraines."

Page Ref: 103—104

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The client is undergoing lab work and ultrasound for a possible diagnosis of polycystic ovarian syndrome (P C O S). Which problem does the nurse expect to find in the client's history?
2. Multiple first-trimester fetal losses
3. Dyspareunia
4. Vulvitis
5. Oligomenorrhea

Page Ref: 104—105

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The client with polycystic ovarian syndrome (P C O S) has been prescribed metformin (Glucophage). The nurse tells the client that the medication will do which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Decrease your excessive hair growth."
2. "Make it easier to lose weight."
3. "Increase your acne."
4. "Improve your chances of pregnancy."
5. "Make your menstrual periods irregular."

Page Ref: 105

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. Abdominal hysterectomy is generally recommended for which condition?
2. Severe endometriosis
3. Removal of the ovaries
4. Suspected or confirmed cancer removal
5. Abnormal uterine bleeding

Page Ref: 106

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Contrast laparoscope-assisted vaginal hysterectomy and abdominal hysterectomy with regard to indications for use and the advantages and disadvantages of each procedure.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. Which of the following systems provides a uniform format and classification of terminology based on current understanding of cervical disease?
2. Levonorgestrel intrauterine
3. P A L M-C O E I N
4. Bethesda
5. B S E

Page Ref: 98

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is preparing teaching materials for female clients who wish to perform breast self-examination. In which order should the nurse ensure that the teaching materials present the process of inspection?
2. Compare the breasts
3. Study the skin surface
4. Analyze for symmetry
5. Study the shape and direction
6. Look at color, thickening, edema, and venous patterns

Page Ref: 89—90

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. During a routine physical examination a female patient asks the nurse what can be done to prevent the development of breast cancer. What should the nurse review with the patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Exercise regularly
2. Discuss starting tamoxifen
3. Reduce the intake of red meat
4. Maintain a normal body weight
5. Reduce the intake of dietary fat

Page Ref: 92—93

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A female patient is anxious about having a pelvic examination. To help reduce the patient's fears in which order should the nurse explain that the examination will be performed?
2. The speculum is inserted
3. The speculum is removed
4. The perineum is inspected
5. The rectal examination is performed
6. The healthcare provider applies gloves
7. The bimanual examination is performed

Page Ref: 95—96

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 10 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. During an interview the nurse learns that a patient's sister was recently diagnosed with endometrial cancer. What should the nurse review to reduce the patient's risk for developing the same disease process?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Smoking cessation
2. Maintain a normal body mass index
3. Consider birth control without estrogen
4. Limit the intake of alcohol to one drink per day
5. Increase exercise to 30 minutes most days of the week

Page Ref: 102—103

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 6 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is reviewing data collected during a health history and physical assessment and suspects that the patient could be experiencing polycystic ovarian syndrome (P C O S). What information did the nurse use to make this clinical determination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Body mass index 31
2. Hair loss and warm moist skin
3. Periods occur every 3 to 4 months
4. Fasting capillary blood glucose 123 m g/d L
5. Inability to become pregnant after 2 years of unprotected intercourse

Page Ref: 104—105

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation; Nursing Process.

Learning Outcome: 7 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A patient receiving chemotherapy for breast cancer writes in a journal during the treatments and reads devotional material. Which phase of psychologic adjustment should the nurse identify that this patient is experiencing?
2. Shock
3. Denial
4. Reaction
5. Recovery

Page Ref: 94

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient centered care. | A A C N Essentials Competencies: Ⅸ. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation.

Learning Outcome: 2 Describe the emotional reactions a woman may experience in regard to a diagnosis of breast cancer.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. During a pelvic examination, a patient is diagnosed with a Bartholin gland cyst. For which treatment should the nurse prepare this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pelvic ultrasound
2. Antibiotic therapy
3. Exploratory laparotomy
4. Incision and drainage of the cyst
5. Culture and sensitivity of the discharge

Page Ref: 97

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning.

Learning Outcome: 3 Identify the implications of an abnormal finding during a pelvic examination.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A patient is demonstrating manifestations of acute cervicitis. Which laboratory test should the nurse expect to be completed for this patient?
2. Sedimentation rate
3. Blood test for V D R L
4. White blood cell count
5. Vaginal smear for S T Is

Page Ref: 97

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning.

Learning Outcome: 3 Identify the implications of an abnormal finding during a pelvic examination.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse is caring for a female client with a history of pelvic inflammatory disease (P I D) who reports having difficulty conceiving after unprotected sex for over 2 years. Which deviation from the norm does the nurse recognize is most likely the cause of the client's infertility?
2. Non-patent fallopian tube
3. Unfavorable cervical mucus
4. Absence of ovulation
5. Abnormal endometrial preparation

Page Ref: 108

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 11 Compare the essential components of fertility with the possible causes of infertility.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. The nurse takes a telephone call from a women's health clinic patient. What information should cause the nurse to suspect that the patient is experiencing a cystocele?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Bloody urine
2. Low back pain
3. Onset of stress incontinence
4. Feeling of fullness in the perineum
5. Feels like something "fell out" of the vagina

Page Ref: 105

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment.

Learning Outcome: 8 Compare the signs and symptoms and treatment options of the three forms of pelvic relaxation–cystocele, rectocele, and uterine relaxation.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A patient with a rectocele is experiencing progressive pain and constipation. What should the nurse expect to be indicated for this patient?
2. Enemas
3. Surgery
4. Laxatives
5. Antibiotics

Page Ref: 105

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning.

Learning Outcome: 8 Compare the signs and symptoms and treatment options of the three forms of pelvic relaxation–cystocele, rectocele, and uterine relaxation.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.

1. A 38-year-old female is scheduled for a laparoscopic-assisted vaginal hysterectomy (L A V H) for severe endometriosis with the removal of both ovaries. What should the nurse expect to be prescribed for this patient postoperatively?
2. Corticosteroid therapy
3. Mineralocorticoid therapy
4. Estrogen replacement therapy
5. Progesterone replacement therapy

Page Ref: 106

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning.

Learning Outcome: 9 Contrast laparoscope-assisted vaginal hysterectomy and abdominal hysterectomy with regard to indications for use and the advantages and disadvantages of each procedure.

M N L L O: Demonstrate use of the nursing process in the care of women genital or breast disorders, or infertility.